Healthcare Provider Details

I. General information

NPI: 1851100465
Provider Name (Legal Business Name): COREY BINGHAM FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 150
LOGAN UT
84341-2549
US

IV. Provider business mailing address

754 S 150 E
SMITHFIELD UT
84335-4710
US

V. Phone/Fax

Practice location:
  • Phone: 435-512-0978
  • Fax:
Mailing address:
  • Phone: 435-512-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10439551-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number10439551-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: