Healthcare Provider Details

I. General information

NPI: 1336709716
Provider Name (Legal Business Name): MICHAEL JAMES SPEED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 200 N STE 600
PROVO UT
84601-3016
US

IV. Provider business mailing address

145 W 200 N STE 600
PROVO UT
84601-3016
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-2781
  • Fax:
Mailing address:
  • Phone: 801-821-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14184904-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60975324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: