Healthcare Provider Details

I. General information

NPI: 1558904375
Provider Name (Legal Business Name): LUCAS ROBINSON APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 W. SOUTH JORDAN PARKWAY SUITE 400
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

489 W SOUTH JORDAN PKWY STE 400
SOUTH JORDAN UT
84095-3985
US

V. Phone/Fax

Practice location:
  • Phone: 801-438-3185
  • Fax: 801-438-3184
Mailing address:
  • Phone: 801-438-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number9033289-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: