Healthcare Provider Details

I. General information

NPI: 1861396012
Provider Name (Legal Business Name): BRANDON CALDWELL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E BEDFORD DR
STANSBURY PARK UT
84074-9290
US

IV. Provider business mailing address

323 E BEDFORD DR
STANSBURY PARK UT
84074-9290
US

V. Phone/Fax

Practice location:
  • Phone: 801-726-3459
  • Fax:
Mailing address:
  • Phone: 801-726-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11275948-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: