Healthcare Provider Details

I. General information

NPI: 1972257483
Provider Name (Legal Business Name): ASHLIE TARESSA FLYNN DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 N 400 E STE 200
TOOELE UT
84074-3440
US

IV. Provider business mailing address

2321 N 400 E STE 200
TOOELE UT
84074-3440
US

V. Phone/Fax

Practice location:
  • Phone: 435-249-0225
  • Fax: 601-808-4381
Mailing address:
  • Phone: 435-249-0225
  • Fax: 601-808-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8994021-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8994021-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: