Provider Demographics
NPI:1720978349
Name:TYSON, JAMES (RN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TYSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 W 7000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4805
Mailing Address - Country:US
Mailing Address - Phone:801-573-7442
Mailing Address - Fax:
Practice Address - Street 1:5258 W 7000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4805
Practice Address - Country:US
Practice Address - Phone:801-573-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13017134-3102163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency