Healthcare Provider Details

I. General information

NPI: 1770039356
Provider Name (Legal Business Name): RYAN WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E TABERNACLE ST STE 104
ST GEORGE UT
84770-2951
US

IV. Provider business mailing address

249 E TABERNACLE ST STE 104
ST GEORGE UT
84770-2951
US

V. Phone/Fax

Practice location:
  • Phone: 435-625-1159
  • Fax: 435-319-8690
Mailing address:
  • Phone: 435-625-1159
  • Fax: 435-319-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7996304-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7996304-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: