Healthcare Provider Details

I. General information

NPI: 1407783152
Provider Name (Legal Business Name): SIERRA SMATHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W BAXTER DR STE 130
SOUTH JORDAN UT
84095-5876
US

IV. Provider business mailing address

4615 S 1225 E
MILLCREEK UT
84117-4167
US

V. Phone/Fax

Practice location:
  • Phone: 385-308-4355
  • Fax:
Mailing address:
  • Phone: 319-361-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14188498
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: