Healthcare Provider Details

I. General information

NPI: 1285306803
Provider Name (Legal Business Name): STUART THAIN PORTER APRN-RNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W CENTER ST
OREM UT
84057-5207
US

IV. Provider business mailing address

2901 W BLUE GRASS BLVD STE 200-513
LEHI UT
84048-4188
US

V. Phone/Fax

Practice location:
  • Phone: 801-903-5903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12714252-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12714252-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: