=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265164040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSIE ALLRED APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2022
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1192 E DRAPER PKWY # 121
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-9356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-830-9887
-----------------------------------------------------
Fax | 801-742-8381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3592 S 2175 E
-----------------------------------------------------
City | MILLCREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84109-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-321-0926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 8267859-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------