Healthcare Provider Details

I. General information

NPI: 1114920402
Provider Name (Legal Business Name): LISA A BARKDULL F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 900 E STE 175
SALT LAKE CITY UT
84102-2981
US

IV. Provider business mailing address

275W 200 N 7
KAYSVILLE UT
84037-1873
US

V. Phone/Fax

Practice location:
  • Phone: 801-456-2333
  • Fax: 801-456-2330
Mailing address:
  • Phone: 801-546-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0389765-22
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166259
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8721544-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: