=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073872909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRAD ROBERT PULSIPHER MSN-FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2012
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12391 S 4000 W
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84096-7012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-302-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14262 S TRAILVIEW WAY
-----------------------------------------------------
City | HERRIMAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84096-8029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-652-9363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 8211624-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------