# GRATEFUL DIRECT PRIMARY CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164221974
- **Authorized official:** WESLEY BRIAN WALSMAN (CLINIC MANAGER)
- **Authorized official phone:** (956) 639-0644

## Contact information

- **Practice address:** 8541 S REDWOOD RD STE B1, WEST JORDAN, UT 84088-9323
- **Practice address phone:** (801) 706-0171
- **Mailing address:** 8541 S REDWOOD RD STE B1, WEST JORDAN, UT 84088-9323
- **Mailing address phone:** (801) 706-0171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/12/2025
- **Last updated:** 03/12/2025