Healthcare Provider Details

I. General information

NPI: 1447966841
Provider Name (Legal Business Name): RILEY WORTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 S ALTAIR DR
SANDY UT
84093-1510
US

IV. Provider business mailing address

8811 S ALTAIR DR
SANDY UT
84093-1510
US

V. Phone/Fax

Practice location:
  • Phone: 801-201-7242
  • Fax:
Mailing address:
  • Phone: 801-201-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10870685-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number10870685-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: