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NPI Code Detail

MEDICARE: TODD ALLEN PMHNP

MEDICARE: TODD ALLEN 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner54603994408UT

General Provider Information

NPI Number : 1366184319
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD ALLEN PMHNP
Provider Business Mailing Address
First Line : 428 W HILLS DR
Second Line :
City : SARATOGA SPRINGS
State : UT
Zip : 84045-3111
Country : US
Telephone Number : 801-857-1314
Fax Number :
Provider Business Practice Location Address
First Line : 3311 N UNIVERSITY AVE STE 200
Second Line :
City : PROVO
State : UT
Zip : 84604-7421
Country : US
Telephone Number : 385-504-1334
Fax Number : 801-210-5812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2022
Last Update Date : 03/27/2023

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