Healthcare Provider Details

I. General information

NPI: 1437899309
Provider Name (Legal Business Name): TIFFANY KAYLA WARREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 N 1000 W
TREMONTON UT
84337-9356
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-207-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax: 877-497-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14199315-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: