Provider Demographics
NPI:1528712973
Name:ADAMS, BRIAN HARDISON
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HARDISON
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BLUFF VIEW DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8910
Mailing Address - Country:US
Mailing Address - Phone:801-850-7393
Mailing Address - Fax:
Practice Address - Street 1:1000 BLUFF VIEW DR UNIT 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8910
Practice Address - Country:US
Practice Address - Phone:801-850-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10656058-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily