Healthcare Provider Details

I. General information

NPI: 1891968004
Provider Name (Legal Business Name): CYNTHIA TERRY JOHNSON APRN, PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KMBL
PROVO UT
84602-4704
US

IV. Provider business mailing address

2325 E BONAIR ST
SALT LAKE CITY UT
84117-6216
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-4227
  • Fax:
Mailing address:
  • Phone: 801-422-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4822498-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: