Provider Demographics
NPI:1164151064
Name:BEATTY, PRESTEN (DNP)
Entity Type:Individual
Prefix:
First Name:PRESTEN
Middle Name:
Last Name:BEATTY
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 S 8400 W STE 110
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-4907
Mailing Address - Country:US
Mailing Address - Phone:801-250-9638
Mailing Address - Fax:
Practice Address - Street 1:3336 S PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2000
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10217335-3102163W00000X
UT10217335-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse