Healthcare Provider Details

I. General information

NPI: 1750233532
Provider Name (Legal Business Name): DYLAN RAY MAYFIELD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 S 1000 E
ST GEORGE UT
84790-5555
US

IV. Provider business mailing address

671 S 1000 E
ST GEORGE UT
84790-5555
US

V. Phone/Fax

Practice location:
  • Phone: 435-215-7533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12611525-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: