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General NPI Number Information
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NPI Number | 1538682851
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Entity Type | Individual
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Provider Name | JASON TYE DNP, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1756 W PARK AVE
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City | RIVERTON
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State | UT
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Zip | 84065-4701
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Country | US
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Telephone | 801-634-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 W PARK AVE
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City | RIVERTON
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State | UT
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Zip | 84065-4701
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Country | US
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Telephone | 801-634-2616
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8377428-4405
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License Number State | UT
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