Provider Demographics
NPI:1932501624
Name:PRATER GEOGHEGAN, LAURA (APRN)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:PRATER GEOGHEGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 N 500 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6948
Mailing Address - Country:US
Mailing Address - Phone:816-779-1100
Mailing Address - Fax:816-779-1119
Practice Address - Street 1:458 N 500 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6948
Practice Address - Country:US
Practice Address - Phone:801-292-9355
Practice Address - Fax:801-296-8050
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014034218363LF0000X
UT12040121-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily