Healthcare Provider Details

I. General information

NPI: 1972424000
Provider Name (Legal Business Name): MISTY GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 S PARK AVE UNIT 520
RIVERTON UT
84065-3422
US

IV. Provider business mailing address

12688 S SERENGETI DR APT 609
RIVERTON UT
84096-7372
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-0047
  • Fax:
Mailing address:
  • Phone: 801-597-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF25-118595
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: