Healthcare Provider Details

I. General information

NPI: 1588549851
Provider Name (Legal Business Name): LISA COLLEEN SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 N 600 E
SPANISH FORK UT
84660-1306
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 385-265-6050
  • Fax: 801-798-7954
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10376826-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: