Healthcare Provider Details

I. General information

NPI: 1093395469
Provider Name (Legal Business Name): CORRINE WHITAKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 W MAIN ST STE B207
LEHI UT
84043-6937
US

IV. Provider business mailing address

2135 W MAIN ST STE B207
LEHI UT
84043-6937
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-3014
  • Fax:
Mailing address:
  • Phone: 801-224-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6263133-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: