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General NPI Number Information
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NPI Number | 1972491462
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Entity Type | Individual
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Provider Name | TYLER PETERSON NP
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Gender | Male
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 134 N 200 E STE 302
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City | ST GEORGE
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State | UT
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Zip | 84770-2899
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Country | US
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Telephone | 288-043-5288
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Fax |
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Provider Business Mailing Address
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Address Line | 656 W VERMILLION WIND LN
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City | ST GEORGE
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State | UT
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Zip | 84790-1996
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12611526-4405
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License Number State | UT
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