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NPI Code Detail

MEDICARE: ALISON SPACKMAN DNP

MEDICARE: ALISON SPACKMAN DNP
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
1163W00000XRegistered Nurse10591453-3102UT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner10591453-8900UT

General Provider Information

NPI Number : 1629965074
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISON SPACKMAN DNP
Provider Business Mailing Address
First Line : 500 FOOTHILL BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84148-0001
Country : US
Telephone Number : 801-582-1565
Fax Number :
Provider Business Practice Location Address
First Line : 500 FOOTHILL BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84148-0001
Country : US
Telephone Number : 801-582-1565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2025
Last Update Date : 06/06/2026

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