Provider Demographics
NPI:1659785772
Name:BIRCH, BECKY ANN (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:ANN
Last Name:BIRCH
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 350 N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066
Mailing Address - Country:US
Mailing Address - Phone:435-722-6144
Mailing Address - Fax:435-722-6122
Practice Address - Street 1:200 WEST 350 NORTH
Practice Address - Street 2:STE 103
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066
Practice Address - Country:US
Practice Address - Phone:435-722-6144
Practice Address - Fax:435-722-6122
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5333772-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care