MEDICARE: BRYCE GOSNEY PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95019258	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13183565-4405	UT

General Provider Information

NPI Number	:	1346993193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYCE GOSNEY PMHNP

Provider Business Mailing Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:	801-791-4975
Fax Number	:	385-541-2753

Provider Business Practice Location Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:	801-686-8488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	03/18/2026

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