Healthcare Provider Details

I. General information

NPI: 1881465359
Provider Name (Legal Business Name): TYLER SCOTT FARNSWORTH PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 3750 S
SOUTH SALT LAKE UT
84115-4428
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-0911
  • Fax:
Mailing address:
  • Phone: 801-393-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13994066-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: