Healthcare Provider Details

I. General information

NPI: 1972830271
Provider Name (Legal Business Name): DARNELL THOMPSON BIRD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

65 W. BANBURY CT.
LEHI UT
84043
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-2401
  • Fax:
Mailing address:
  • Phone: 801-592-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4822505-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: