Provider Demographics
NPI:1447966841
Name:WORTH, RILEY (NP)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 S ALTAIR DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1510
Mailing Address - Country:US
Mailing Address - Phone:801-201-7242
Mailing Address - Fax:
Practice Address - Street 1:8811 S ALTAIR DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1510
Practice Address - Country:US
Practice Address - Phone:801-201-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10870685-4405363LF0000X
UT10870685-3102163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery