Provider Demographics
NPI:1396493086
Name:WHEATFILL, BRETT (FNP)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WHEATFILL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:
Practice Address - Street 1:691 E 400 N STE 110
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-7509
Practice Address - Country:US
Practice Address - Phone:385-203-0246
Practice Address - Fax:385-203-0245
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95053192363LF0000X
UT9428409-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily