Healthcare Provider Details

I. General information

NPI: 1912832569
Provider Name (Legal Business Name): NICOLE BEARDALL DENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N 400 E APT 125
LOGAN UT
84341-5636
US

IV. Provider business mailing address

1651 N 400 E APT 125
LOGAN UT
84341-5636
US

V. Phone/Fax

Practice location:
  • Phone: 208-540-1261
  • Fax:
Mailing address:
  • Phone: 208-540-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06260856
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: