Healthcare Provider Details

I. General information

NPI: 1992985535
Provider Name (Legal Business Name): CARLOTTA KAY VEASY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 COLLEGE DR SUITE 302
MURRAY UT
84123-2672
US

IV. Provider business mailing address

4755 WANDER LN
HOLLADAY UT
84117-5459
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-5086
  • Fax:
Mailing address:
  • Phone: 801-550-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number208714-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: