Provider Demographics
NPI:1295535912
Name:STEVENSON, TAELYR (APRN)
Entity type:Individual
Prefix:
First Name:TAELYR
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 N 200 E
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-7103
Mailing Address - Country:US
Mailing Address - Phone:801-400-4662
Mailing Address - Fax:
Practice Address - Street 1:1250 E 3900 S STE 440
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1349
Practice Address - Country:US
Practice Address - Phone:801-869-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108268904405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner