Healthcare Provider Details

I. General information

NPI: 1821453200
Provider Name (Legal Business Name): TRACI NAYLOR APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACI BUXTON BSN

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E 1200 S
OREM UT
84058-6904
US

IV. Provider business mailing address

361 E 1200 S STE 201
OREM UT
84058-6904
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-3014
  • Fax:
Mailing address:
  • Phone: 801-224-3014
  • Fax: 801-224-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number291500-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number291500-3102
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: