Healthcare Provider Details

I. General information

NPI: 1124745831
Provider Name (Legal Business Name): DANIEL SLY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W 2710 SOUTH CIR STE 202A
SAINT GEORGE UT
84790-7205
US

IV. Provider business mailing address

169 W 2710 SOUTH CIR STE 202A
SAINT GEORGE UT
84790-7205
US

V. Phone/Fax

Practice location:
  • Phone: 435-574-9090
  • Fax: 210-610-5485
Mailing address:
  • Phone: 435-669-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1072962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: