Individual
BRANDON THATCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
F.M.H.N.P
Contact information
Practice address
1750 N WYMOUNT TERRACE DR, PROVO, UT 84602-7600
(801) 422-5156
Mailing address
1750 N WYMOUNT TERRACE DR, PROVO, UT 84602-7600
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7393923-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669814505
—
UT
Enumeration date
07/19/2013
Last updated
09/01/2017
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