Healthcare Provider Details

I. General information

NPI: 1770187163
Provider Name (Legal Business Name): GADZOOM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N THANKSGIVING WAY STE 190
LEHI UT
84048-4157
US

IV. Provider business mailing address

3401 N THANKSGIVING WAY STE 190
LEHI UT
84048-4157
US

V. Phone/Fax

Practice location:
  • Phone: 385-454-5027
  • Fax:
Mailing address:
  • Phone: 385-454-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN NEWBERRY
Title or Position: MANAGER
Credential:
Phone: 385-454-5027