Healthcare Provider Details

I. General information

NPI: 1326957200
Provider Name (Legal Business Name): CHARLES CONOVER CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

11978 S REDWOOD RD
RIVERTON UT
84065-7403
US

IV. Provider business mailing address

11978 S REDWOOD RD
RIVERTON UT
84065-7403
US

V. Phone/Fax

Practice location:
  • Phone: 801-679-3921
  • Fax:
Mailing address:
  • Phone: 801-679-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberF26-167278
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: