Provider Demographics
NPI:1437706058
Name:HEAPS, AUSTIN SUMNER
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SUMNER
Last Name:HEAPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4571
Mailing Address - Country:US
Mailing Address - Phone:801-479-4105
Mailing Address - Fax:
Practice Address - Street 1:1044 N 600 E
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9269
Practice Address - Country:US
Practice Address - Phone:801-310-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9518515-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health