MEDICARE: MATTHEW JONATHAN BADGER FNP

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	363L00000X	Nurse Practitioner	319180-4405	UT
2	363LF0000X	Family Nurse Practitioner	319180-4405	UT

General Provider Information

NPI Number	:	1912029778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JONATHAN BADGER FNP

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 N 300 W STE 400
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3359
Country	:	US
Telephone Number	:	801-357-7404
Fax Number	:	801-357-7587

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	04/13/2026

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