Provider Demographics
NPI:1134884208
Name:TEYA WILSON DNP
Entity type:Organization
Organization Name:TEYA WILSON DNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEYA
Authorized Official - Middle Name:CHILTON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:801-721-2548
Mailing Address - Street 1:2561 S 1560 W STE B
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:
Practice Address - Street 1:5089 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5731
Practice Address - Country:US
Practice Address - Phone:801-743-0700
Practice Address - Fax:801-743-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5292638-4405OtherLICENSE