Healthcare Provider Details

I. General information

NPI: 1437706058
Provider Name (Legal Business Name): AUSTIN SUMNER HEAPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 S 2500 E STE 2A
UINTAH UT
84405
US

IV. Provider business mailing address

6696 S 2500 E STE 2A
UINTAH UT
84405
US

V. Phone/Fax

Practice location:
  • Phone: 385-382-1555
  • Fax: 877-851-4180
Mailing address:
  • Phone: 385-382-1555
  • Fax: 877-851-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9518515-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: