NPI |
1144084807 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
DART |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Name |
AMY |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
GWYNN |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
48 W 1500 N |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
NEPHI |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
UT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
846488900 |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4356233065 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Enumeration Date |
2/12/2024 |
The date that a record was last updated or changed. |
Last Update Date |
2/12/2024 |
The code designating the provider’s gender if the provider is a person. |
Provider Gender Code |
F |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Taxonomy Code 1 |
235Z00000X |
The country code in the location address of the provider being identified. |
Provider License Number 1 |
129708324102 |
The telephone number associated with the location address of the provider being identified. |
Provider License Number State Code 1 |
UT |
The date the provider was assigned a unique identifier (assigned an NPI). |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
2/12/2024 |
|