Provider Demographics
NPI:1578654224
Name:ADAMS, BRYAN (NP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2288
Mailing Address - Country:US
Mailing Address - Phone:801-766-9822
Mailing Address - Fax:801-766-9441
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2288
Practice Address - Country:US
Practice Address - Phone:801-766-9822
Practice Address - Fax:801-766-9441
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT197032-4405225400000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT500018008OtherPALMETTO
UT61565OtherPEHP
UTS97092Medicare UPIN
UT500018008OtherPALMETTO