Provider Demographics
NPI:1194262022
Name:ALLRED, MATTHEW (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ALLRED
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S
Mailing Address - Street 2:SUITE 405
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5710
Mailing Address - Country:US
Mailing Address - Phone:801-568-3480
Mailing Address - Fax:801-562-3140
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 405
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5710
Practice Address - Country:US
Practice Address - Phone:801-568-3480
Practice Address - Fax:801-562-3140
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7765348-4408363LF0000X
UT7765348-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily