Provider Demographics
NPI:1306723861
Name:RANDALL, NEAL (PMHNP-DNP, APRN)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:PMHNP-DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5092 S 1800 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2952
Mailing Address - Country:US
Mailing Address - Phone:801-710-4276
Mailing Address - Fax:
Practice Address - Street 1:101 N FORT LN APT 105A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3409
Practice Address - Country:US
Practice Address - Phone:801-710-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10379256-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health