Provider Demographics
NPI:1093503336
Name:WARREN, CASSIDY (APRN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:WARREN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 E 100 N STE 4
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2345
Mailing Address - Country:US
Mailing Address - Phone:801-836-1642
Mailing Address - Fax:
Practice Address - Street 1:641 W 1290 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2327
Practice Address - Country:US
Practice Address - Phone:801-796-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11794922-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily