Individual
CLINT W PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
5600 HERITAGE SCHOOL DR, PROVO, UT 84604-7701
(801) 226-4659
(801) 705-5362
Mailing address
1266 OAK HILL CIR, PROVO, UT 84604-3726
(801) 234-9543
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
5938005-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5938005-4408
UT
Other
Enumeration date
07/17/2009
Last updated
04/17/2025
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