Healthcare Provider Details

I. General information

NPI: 1679079784
Provider Name (Legal Business Name): SHELBY ABDULLA PITTS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 WASATCH DR STE A
OGDEN UT
84403-4993
US

IV. Provider business mailing address

5544 S 1425 E
OGDEN UT
84403-5160
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-6974
  • Fax: 877-550-0662
Mailing address:
  • Phone: 801-920-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7977558-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: