Healthcare Provider Details

I. General information

NPI: 1467260729
Provider Name (Legal Business Name): RYAN CHANDLER REED PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S MAIN ST STE 100
LOGAN UT
84321-5765
US

IV. Provider business mailing address

701 S MAIN ST STE 100
LOGAN UT
84321-5765
US

V. Phone/Fax

Practice location:
  • Phone: 435-915-7069
  • Fax:
Mailing address:
  • Phone: 435-915-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11690131-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11690131-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: