Provider Demographics
NPI:1346770286
Name:LEATHAM, SCOTT ALLAN (NP-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:LEATHAM
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2251
Mailing Address - Country:US
Mailing Address - Phone:801-529-8319
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2251
Practice Address - Country:US
Practice Address - Phone:801-768-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8625964-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily