Healthcare Provider Details

I. General information

NPI: 1417526864
Provider Name (Legal Business Name): SAMANTHA WHITEHEAD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA CRISMON

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 1140 N STE B
SARATOGA SPRINGS UT
84045-5467
US

IV. Provider business mailing address

41 E 1140 N STE B
SARATOGA SPRINGS UT
84045-5467
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-6500
  • Fax:
Mailing address:
  • Phone: 801-407-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5942923-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5942923-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: