Healthcare Provider Details

I. General information

NPI: 1568044881
Provider Name (Legal Business Name): MRS. ASHTON PLOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 FAIRFIELD DR
MORGAN UT
84050-6788
US

IV. Provider business mailing address

5925 FAIRFIELD DR
MORGAN UT
84050-6788
US

V. Phone/Fax

Practice location:
  • Phone: 760-219-6736
  • Fax:
Mailing address:
  • Phone: 760-219-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9256596-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: