Healthcare Provider Details

I. General information

NPI: 1225894751
Provider Name (Legal Business Name): SHANNON L COMPTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date: 07/26/2024
Reactivation Date: 08/06/2024

III. Provider practice location address

598 W 900 S
WOODS CROSS UT
84010-8235
US

IV. Provider business mailing address

598 W 900 S
WOODS CROSS UT
84010-8235
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5111
  • Fax:
Mailing address:
  • Phone: 801-475-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7865907-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: