Healthcare Provider Details

I. General information

NPI: 1245804723
Provider Name (Legal Business Name): TYRONE BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 1300 S
SALT LAKE CITY UT
84115-5230
US

IV. Provider business mailing address

120 W 1300 S
SALT LAKE CITY UT
84115-5230
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-4877
  • Fax:
Mailing address:
  • Phone: 801-486-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: