Provider Demographics
NPI:1821763822
Name:SUBLETT, TAYLOR LOLA (PMHDNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LOLA
Last Name:SUBLETT
Suffix:
Gender:F
Credentials:PMHDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 E 4800 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5049
Mailing Address - Country:US
Mailing Address - Phone:801-264-9522
Mailing Address - Fax:
Practice Address - Street 1:845 E 4800 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5049
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9805840-8900363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health