Healthcare Provider Details

I. General information

NPI: 1912436478
Provider Name (Legal Business Name): MATTHEW R HARVEY NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 135
LOGAN UT
84341-2549
US

IV. Provider business mailing address

PO BOX 912042
SAINT GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-8146
  • Fax:
Mailing address:
  • Phone: 435-215-0230
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number55473
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10391008-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: