Provider Demographics
NPI:1841888211
Name:THOMAS, HILARY (FNP)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:GRACE THOMAS
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11693 S 700 E STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7573
Mailing Address - Country:US
Mailing Address - Phone:801-810-2147
Mailing Address - Fax:
Practice Address - Street 1:8841 S REDWOOD RD STE D
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9289
Practice Address - Country:US
Practice Address - Phone:801-610-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11565771-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT15053336Medicaid