Healthcare Provider Details

I. General information

NPI: 1588580849
Provider Name (Legal Business Name): BYRON WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E BRIDLEWALK LN
MURRAY UT
84107-6622
US

IV. Provider business mailing address

351 E BRIDLEWALK LN
MURRAY UT
84107-6622
US

V. Phone/Fax

Practice location:
  • Phone: 801-946-9702
  • Fax:
Mailing address:
  • Phone: 801-946-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number161709210
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: