Healthcare Provider Details

I. General information

NPI: 1194131516
Provider Name (Legal Business Name): DRAKE SCOTT MASON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 11/27/2023
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 S MAIN ST
MONROE UT
84754-4400
US

IV. Provider business mailing address

1055 NORTH 500 WEST ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 435-527-8866
  • Fax: 435-527-4436
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8258307-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number8258307-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: