Individual
MR. SHADRICK WYATT TILLOTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
2901 W BLUE GRASS BLVD STE 200, LEHI, UT 84043-4190
(385) 510-5150
(866) 748-5235
Mailing address
2901 W BLUE GRASS BLVD STE 200, LEHI, UT 84043-4190
(385) 510-5150
(866) 748-5235
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
6223314-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6223314-4405
UT
Other
Enumeration date
08/28/2016
Last updated
04/02/2024
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