Healthcare Provider Details

I. General information

NPI: 1023971660
Provider Name (Legal Business Name): ATHENA SPLETT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S REDWOOD RD
SALT LAKE CITY UT
84104-5112
US

IV. Provider business mailing address

68 P ST
SALT LAKE CITY UT
84103-3942
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-2846
  • Fax:
Mailing address:
  • Phone: 801-835-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13552093-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: