Provider Demographics
NPI:1295519817
Name:PEMBERTON, TONI (FNP-BC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S COYOTE RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84737-4921
Mailing Address - Country:US
Mailing Address - Phone:435-669-5952
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE N
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2579
Practice Address - Country:US
Practice Address - Phone:435-246-7409
Practice Address - Fax:435-355-3898
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365511-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily