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General NPI Number Information
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NPI Number | 1598532301
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Entity Type | Individual
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Provider Name | PEYTON RUSTY COOMBS NP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 775 S MAIN ST STE A
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City | LOGAN
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State | UT
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Zip | 84321-5402
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Country | US
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Telephone | 435-562-3133
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Fax |
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Provider Business Mailing Address
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Address Line | 1678 E 1700 N
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City | LOGAN
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State | UT
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Zip | 84341-2146
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Country | US
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Telephone | 801-928-9020
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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 | 14160393-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9646747-3102
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License Number State | UT
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