Provider Demographics
NPI:1396610408
Name:ARCHIBALD, CALLY (APRN)
Entity type:Individual
Prefix:
First Name:CALLY
Middle Name:
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 E TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4564
Mailing Address - Country:US
Mailing Address - Phone:385-535-7976
Mailing Address - Fax:
Practice Address - Street 1:2044 E TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4564
Practice Address - Country:US
Practice Address - Phone:385-535-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9495272-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily