Healthcare Provider Details

I. General information

NPI: 1578245544
Provider Name (Legal Business Name): PEAKS ADVANCED MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 N 3000 W
OGDEN UT
84404-9528
US

IV. Provider business mailing address

1066 N 3000 W
OGDEN UT
84404-9528
US

V. Phone/Fax

Practice location:
  • Phone: 385-501-6052
  • Fax: 801-820-2849
Mailing address:
  • Phone: 385-501-6052
  • Fax: 801-820-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MCKENZIE BRIGHT
Title or Position: OWNER
Credential:
Phone: 385-501-6052