Healthcare Provider Details

I. General information

NPI: 1932672011
Provider Name (Legal Business Name): CHAZ DAVIS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 E RIVERSIDE DR STE A200
ST GEORGE UT
84790-8693
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-9298
  • Fax: 435-628-9655
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 Number11103138-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: