Healthcare Provider Details

I. General information

NPI: 1407294903
Provider Name (Legal Business Name): PHILLIP DON TAYLOR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 400 W
SALT LAKE CITY UT
84101-2201
US

IV. Provider business mailing address

1303 UNIVERSITY VLG
SALT LAKE CITY UT
84108-3511
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-0058
  • Fax:
Mailing address:
  • Phone: 801-585-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5144080-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: