Healthcare Provider Details

I. General information

NPI: 1700237740
Provider Name (Legal Business Name): AMMON HAYMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 E RIVERSIDE DR
ST GEORGE UT
84790-2636
US

IV. Provider business mailing address

2276 E RIVERSIDE DR
ST GEORGE UT
84790-2636
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-2565
  • Fax:
Mailing address:
  • Phone: 435-986-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9611455-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: