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General NPI Number Information
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NPI Number | 1710638374
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Entity Type | Individual
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Provider Name | TYSON WILLIAM CATMULL NP-C
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Gender | Male
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 6777 W DUSTIN CIR
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City | HERRIMAN
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State | UT
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Zip | 84096-6933
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Country | US
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Telephone | 801-694-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 6777 W DUSTIN CIR
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City | HERRIMAN
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State | UT
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Zip | 84096-6933
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Country | US
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Telephone | 801-694-1743
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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 | 7717929-4405
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License Number State | UT
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