Brynna Haddock, FNP-C
Nurse Practitioner in Provo, UT. Individual provider (NPI-1).
NPI number1104622158
StatusActive
Last updated in NPPESMar 7, 2025
Details
- NPI
- 1104622158
- Entity type
- Individual (NPI-1)
- Name
- Brynna Haddock
- Credential
- FNP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 20, 2025
- Certification date
- Mar 7, 2025
- Last updated
- Mar 7, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 14205405-4405 | UT | Yes |
| 207Q00000X | Family Medicine | 14205405-4405 | UT |
Other names
- Brynna Wilson (Former Name)
Practice location
1055 N 500 W Ste 222Provo, UT 84604-3305
Phone 801-354-8225 · Fax 801-418-0941
Mailing address
1055 N 500 WAttn: Credentialing
Provo, UT 84604-3305
Phone 801-354-8225 · Fax 801-418-0941
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