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General NPI Number Information
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NPI Number | 1356167985
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Entity Type | Individual
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Provider Name | CHANEL GATES PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1221 S VALLEY GROVE WAY STE 160
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6758
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Country | US
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Telephone | 801-477-7189
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 S CONNOR ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-2401
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Country | US
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Telephone | 801-809-7145
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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 | 10196181-4405
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License Number State | UT
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