Provider Demographics
NPI:1295428654
Name:MCHENRY, AMBER (FNP-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 S UNION PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4171
Mailing Address - Country:US
Mailing Address - Phone:385-243-4225
Mailing Address - Fax:
Practice Address - Street 1:7050 UNION PARK CENTER
Practice Address - Street 2:STE # 200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:385-243-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5780899-4405363LF0000X
UT5780899-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily