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General NPI Number Information
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NPI Number | 1285430207
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Entity Type | Organization
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Legal Business Name | NORTHERN VALLEY FAMILY MEDICINE
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1415 N 400 E STE A
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City | LOGAN
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State | UT
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Zip | 84341-7539
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Country | US
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Telephone | 435-753-2840
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Fax | 435-787-9422
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Provider Business Mailing Address
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Address Line | 415 W 3400 S
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City | NIBLEY
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State | UT
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Zip | 84321-6461
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Country | US
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Telephone | 801-557-5024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY LYNN TAGG
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Credential | FNP
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Telephone | 801-557-5024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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