Healthcare Provider Details

I. General information

NPI: 1437084035
Provider Name (Legal Business Name): HAPPY VALLEY CLINIC 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 4500 S STE 102
MURRAY UT
84107-4254
US

IV. Provider business mailing address

310 E 4500 S STE 102
MURRAY UT
84107-4254
US

V. Phone/Fax

Practice location:
  • Phone: 833-336-6386
  • Fax:
Mailing address:
  • Phone: 833-336-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BROCK ROBERTS
Title or Position: OWNER
Credential:
Phone: 833-336-6386