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General NPI Number Information
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NPI Number | 1578245544
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Entity Type | Organization
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Legal Business Name | PEAKS ADVANCED MEDICAL
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1066 N 3000 W
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City | OGDEN
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State | UT
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Zip | 84404-9528
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Country | US
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Telephone | 385-501-6052
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Fax | 801-820-2849
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Provider Business Mailing Address
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Address Line | 1066 N 3000 W
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City | OGDEN
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State | UT
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Zip | 84404-9528
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Country | US
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Telephone | 385-501-6052
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Fax | 801-820-2849
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Authorized Official
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Title or Position | OWNER
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Name | MCKENZIE BRIGHT
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Credential |
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Telephone | 385-501-6052
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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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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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