Healthcare Provider Details

I. General information

NPI: 1184536104
Provider Name (Legal Business Name): HARRISON DEVERS TAFF AEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COTTAGE WAY
MIDVALE UT
84047-5047
US

IV. Provider business mailing address

103 COTTAGE WAY
MIDVALE UT
84047-5047
US

V. Phone/Fax

Practice location:
  • Phone: 256-425-5136
  • Fax:
Mailing address:
  • Phone: 256-425-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number2400768
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberA2060170
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: