Provider Demographics
NPI:1356679641
Name:HAIGHT, REGAN (APRN)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:HAIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0872
Mailing Address - Country:US
Mailing Address - Phone:801-712-1623
Mailing Address - Fax:801-701-1009
Practice Address - Street 1:388 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4659
Practice Address - Country:US
Practice Address - Phone:801-960-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376041-4405363L00000X, 363LP0808X, 163WP0808X
UT376041-8900163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1427565415Medicaid
UT376041-8900OtherSTATE CONTROLLED SUBSTANCE LICENSE
UT376041-4405OtherSTATE LICENSE