Healthcare Provider Details

I. General information

NPI: 1659903276
Provider Name (Legal Business Name): AMY SARAH THOMPSON NP-DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 W 1675 S
WEST HAVEN UT
84401-6766
US

IV. Provider business mailing address

3876 W 2275 S
TAYLOR UT
84401-7142
US

V. Phone/Fax

Practice location:
  • Phone: 801-389-7000
  • Fax:
Mailing address:
  • Phone: 801-389-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number343058-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number343058-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: