Provider Demographics
NPI:1972979300
Name:ALLRED, ANNELIESA (APRN)
Entity type:Individual
Prefix:
First Name:ANNELIESA
Middle Name:
Last Name:ALLRED
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 1:2019 S MOUNTAIN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2545
Mailing Address - Country:US
Mailing Address - Phone:801-361-7650
Mailing Address - Fax:
Practice Address - Street 1:2297 N HILL FIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6927
Practice Address - Country:US
Practice Address - Phone:385-888-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083711-4405363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care