Healthcare Provider Details

I. General information

NPI: 1952821753
Provider Name (Legal Business Name): STACY ANN PARRY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 E 3900 S STE 100
SALT LAKE CITY UT
84124-1550
US

IV. Provider business mailing address

1521 E 3900 S STE 100
SALT LAKE CITY UT
84124-1550
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-3800
  • Fax: 801-268-3997
Mailing address:
  • Phone: 801-268-3800
  • Fax: 801-268-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3098529-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3098529-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: