Healthcare Provider Details

I. General information

NPI: 1164151064
Provider Name (Legal Business Name): PRESTEN BEATTY DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 S PIONEER PKWY
SALT LAKE CITY UT
84120-2000
US

IV. Provider business mailing address

3665 S 8400 W STE 110
MAGNA UT
84044-4907
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax:
Mailing address:
  • Phone: 801-250-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10217335-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10217335-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10217335-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: