Provider Demographics
NPI:1770192106
Name:PORTER, SARAH THEO (DNP, APRN, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:THEO
Last Name:PORTER
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 RIVERDALE RD # 1138
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-1717
Mailing Address - Country:US
Mailing Address - Phone:801-999-1384
Mailing Address - Fax:385-364-4055
Practice Address - Street 1:291 S 200 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2419
Practice Address - Country:US
Practice Address - Phone:801-213-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7594463-8900363LP0808X
UT7594463-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health