Healthcare Provider Details

I. General information

NPI: 1508710781
Provider Name (Legal Business Name): CALEB CHACON PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S BLUFF ST STE 302
ST GEORGE UT
84770-3591
US

IV. Provider business mailing address

1647 E SUNSHINE TRL
ST GEORGE UT
84790-1694
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-8848
  • Fax: 435-634-8884
Mailing address:
  • Phone: 435-236-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12712328-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: