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Individual

BRENT JAMES BULLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP, APRN

Contact information

Practice address
1688 N 210 E, OREM, UT 84057-2203
(385) 233-7689
Mailing address
1688 N 210 E, OREM, UT 84057-2203
(385) 233-7689

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
8695221-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
8695221-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8695221-8900
UT

Other

Enumeration date
12/29/2022
Last updated
02/09/2026
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