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General NPI Number Information
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NPI Number | 1174457741
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Entity Type | Individual
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Provider Name | DEZMOND THORLEY SWAIN PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 9289 S REDWOOD RD STE C
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City | WEST JORDAN
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State | UT
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Zip | 84088-6731
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Country | US
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Telephone | 801-568-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 239 E 975 S
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City | LAYTON
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State | UT
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Zip | 84041-4175
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Country | US
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Telephone | 801-979-2898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12512646-4405
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License Number State | UT
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