Healthcare Provider Details

I. General information

NPI: 1700121332
Provider Name (Legal Business Name): CHRISTIAN MICHAEL JUDD DNP APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2012
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E MAIN ST UNIT 332
LEHI UT
84043-4213
US

IV. Provider business mailing address

4460 S HIGHLAND DR STE 210
SALT LAKE CITY UT
84124-3550
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-3356
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5254477-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number5254477-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: