Healthcare Provider Details

I. General information

NPI: 1174262596
Provider Name (Legal Business Name): DAVID HARLESS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 S STEEPLECHASE RD
WASHINGTON UT
84780-4801
US

IV. Provider business mailing address

3961 S STEEPLECHASE RD
WASHINGTON UT
84780-4801
US

V. Phone/Fax

Practice location:
  • Phone: 435-817-3414
  • Fax:
Mailing address:
  • Phone: 435-817-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10836585-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10836585-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907272
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: