Healthcare Provider Details

I. General information

NPI: 1164168035
Provider Name (Legal Business Name): BRYTERSON MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S 315 E
SALEM UT
84653-5845
US

IV. Provider business mailing address

1423 S 315 E
SALEM UT
84653-5845
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-9585
  • Fax:
Mailing address:
  • Phone: 801-367-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BRINGHURST
Title or Position: OWNER
Credential: FNP
Phone: 801-367-9585