Provider Demographics
NPI:1750993341
Name:ROBERTS, ALLYSON (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:LEE
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12257 S BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8126
Mailing Address - Country:US
Mailing Address - Phone:801-816-1444
Mailing Address - Fax:
Practice Address - Street 1:12257 S BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8126
Practice Address - Country:US
Practice Address - Phone:801-816-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101961603102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner