Healthcare Provider Details

I. General information

NPI: 1174457741
Provider Name (Legal Business Name): DEZMOND THORLEY SWAIN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9289 S REDWOOD RD STE C
WEST JORDAN UT
84088-6731
US

IV. Provider business mailing address

239 E 975 S
LAYTON UT
84041-4175
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-2898
  • Fax:
Mailing address:
  • Phone: 801-979-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12512646-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: