Healthcare Provider Details

I. General information

NPI: 1194262022
Provider Name (Legal Business Name): MATTHEW ALLRED A.P.R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 W 9000 S SUITE 405
WEST JORDAN UT
84088-5710
US

IV. Provider business mailing address

3584 W 9000 S SUITE 405
WEST JORDAN UT
84088-5710
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-3480
  • Fax: 801-562-3140
Mailing address:
  • Phone: 801-568-3480
  • Fax: 801-562-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7765348-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7765348-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: