Healthcare Provider Details

I. General information

NPI: 1093647125
Provider Name (Legal Business Name): TREVOR ATCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

21360 N 1450 E
MORONI UT
84646-7629
US

IV. Provider business mailing address

HC 13 BOX 4236
FAIRVIEW UT
84629-9622
US

V. Phone/Fax

Practice location:
  • Phone: 435-262-1217
  • Fax:
Mailing address:
  • Phone: 801-471-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: