Provider Demographics
NPI:1598532301
Name:COOMBS, PEYTON RUSTY (RN)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:RUSTY
Last Name:COOMBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 E 1700 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2146
Mailing Address - Country:US
Mailing Address - Phone:801-928-9020
Mailing Address - Fax:
Practice Address - Street 1:775 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5402
Practice Address - Country:US
Practice Address - Phone:435-562-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9646747-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse