Provider Demographics
NPI:1639773633
Name:FELT, JOSHUA RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RICHARD
Last Name:FELT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2727
Mailing Address - Country:US
Mailing Address - Phone:801-699-4409
Mailing Address - Fax:
Practice Address - Street 1:650 E 4500 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4536
Practice Address - Country:US
Practice Address - Phone:801-261-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8292376-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered