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General NPI Number Information
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NPI Number | 1295535912
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Entity Type | Individual
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Provider Name | TAELYR STEVENSON APRN
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1250 E 3900 S STE 440
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1349
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Country | US
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Telephone | 801-869-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 278 N 200 E
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City | SANTAQUIN
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State | UT
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Zip | 84655-7103
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Country | US
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Telephone | 801-400-4662
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 108268904405
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License Number State | UT
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