=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932672011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAZ DAVIS FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2019
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2019 E RIVERSIDE DR STE A200
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-8693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-628-9298
-----------------------------------------------------
Fax | 435-628-9655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 N 500 W ATTN CREDENTIALING
-----------------------------------------------------
City | PROVO
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-354-8225
-----------------------------------------------------
Fax | 801-418-0941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11103138-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------