Provider Demographics
NPI:1568260750
Name:ROCKY MOUNTAIN CHILD AND ADOLESCENT PSYCHIATRY
Entity type:Organization
Organization Name:ROCKY MOUNTAIN CHILD AND ADOLESCENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:208-850-8440
Mailing Address - Street 1:6041 S 3650 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-1066
Mailing Address - Country:US
Mailing Address - Phone:801-896-9499
Mailing Address - Fax:
Practice Address - Street 1:6041 S 3650 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1066
Practice Address - Country:US
Practice Address - Phone:801-896-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty