Healthcare Provider Details

I. General information

NPI: 1063973832
Provider Name (Legal Business Name): HOLLY LEE CARTER APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S 100 E
PAYSON UT
84651-2201
US

IV. Provider business mailing address

29 W COTTAGE AVE
SANDY UT
84070-1474
US

V. Phone/Fax

Practice location:
  • Phone: 385-236-4234
  • Fax: 385-324-6610
Mailing address:
  • Phone: 385-236-4234
  • Fax: 385-324-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344698-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: