Healthcare Provider Details

I. General information

NPI: 1255513107
Provider Name (Legal Business Name): JOSHUA RAPHAEL PHELPS FNP, D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WASHINGTON BLVD SUITE 104
OGDEN UT
84401-6850
US

IV. Provider business mailing address

1900 WASHINGTON BLVD SUITE 104
OGDEN UT
84401-6850
US

V. Phone/Fax

Practice location:
  • Phone: 801-612-1085
  • Fax: 801-337-1104
Mailing address:
  • Phone: 801-612-1085
  • Fax: 801-337-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7387085-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7387085-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: