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General NPI Number Information
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NPI Number | 1275099897
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH FAMILY PRACTICE
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 240 E CENTER STREET
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City | PROVO
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State | UT
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Zip | 84606
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Country | US
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Telephone | 801-877-5801
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Fax | 801-877-5802
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Provider Business Mailing Address
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Address Line | 240 E CENTER STREET
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City | PROVO
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State | UT
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Zip | 84606
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Country | US
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Telephone | 801-877-5801
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Fax | 801-877-5802
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Authorized Official
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Title or Position | OWNER/NP
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Name | CONNIE TAYLOR
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Credential | NP
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Telephone | 801-877-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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