Healthcare Provider Details

I. General information

NPI: 1053274704
Provider Name (Legal Business Name): BRADY JOHN MORLOCK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2862 S 8200 W
MAGNA UT
84044-1316
US

IV. Provider business mailing address

2862 S 8200 W
MAGNA UT
84044-1316
US

V. Phone/Fax

Practice location:
  • Phone: 801-635-6127
  • Fax:
Mailing address:
  • Phone: 801-635-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12656411-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: