MR. MICHAEL CHARLES DESJARDINS (NPI# 1801924766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801924766 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL CHARLES DESJARDINS |
| Credential | MSN, APRN |
| Practice Address |
668 E 12225 S Ste 203 Draper UT 84020-8385 |
| Mailing Address |
Po Box 1812 Draper UT 84020-1812 |
| Practice Telephone | 8015728255 |
| Practice Fax Number | 8015728144 |
| Mailing Telephone | 8015189203 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-09-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
377701-4405 | UT | Allopathic & Osteopathic Physicians |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
377701-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | LICENSE | 3777014408 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5689 S Redwood Rd Unit 30, Taylorsville, UT 841235499 | 8012681715 | 8012681783 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487297214 | Michael Desjardins | Student in an Organized Health Care Education/Training Program | 73 Francis Street, Boston, MA 02115 | 2019-10-24 |
| Street Address |
668 E 12225 S STE 203 |
| City | DRAPER |
| State | UT |
| Zip Code | 84020-8385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322776 | Chase Larsen Dmd Pllc | Dentist | 723 E 12200 S, Draper, UT 84020 | 2020-10-06 |
| 1780222380 | Derek Cragun | Counselor | 11706 700 E, Draper, UT 84020 | 2019-12-13 |
| 1720629371 | Own My Health Medical | Clinic/Center | 12371 900 E, Suite 102, Draper, UT 84020 | 2019-10-04 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1124670872 | Necia Dalley | Registered Nurse | 11800 S State St, Draper, UT 84020 | 2019-07-12 |
| 1285100784 | Tracey M Williams | Psychologist | 13200 S 1601 E, Draper, UT 84020 | 2018-10-23 |
| 1275008328 | Amoni Paeahelotu Finau | Community Health Worker | 13703 Wheatfield Way, Draper, UT 84020 | 2018-10-04 |
| 1891275525 | Cynthia Mae Bolton | Psychologist | 1192 E Draper Parkway # 447, Draper, UT 84020 | 2018-08-21 |
| 1164908026 | Headin' Home Inc. | Community/Behavioral Health | 12300 S. 150 W., Draper, UT 84020 | 2018-07-13 |
| 1366932576 | Forest Hulet | Dentist | 219 E 12300, Ste I-5, Draper, UT 84020 | 2018-05-14 |
| Find all providers in zip 84020 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992321137 | Mariana Nibley | Nurse Practitioner | 11762 S State St Ste 160, Draper, UT 84020-7174 | 2020-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114536737 | Bradley Martin | Nurse Practitioner | 31 M St Apt 110, Salt Lake City, UT 84103-3846 | 2020-07-29 |
| 1710595178 | Shannon Lee Zaryoun | Nurse Practitioner | 7970 S Grand Vista Way, Cottonwood Heights, UT 84121-5683 | 2020-07-21 |
| 1023640851 | Senior Nurse Practitioner Consultants | Nurse Practitioner | 5802 S 900 E # 3, Murray, UT 84121-1644 | 2020-02-10 |
| 1245877448 | Carla Lucile Applegate-anderson | Nurse Practitioner | 2666 South 2000 East, Suite 101, Salt Lake City, UT 84109 | 2019-12-06 |
| 1124676044 | Marie R. Hurst | Nurse Practitioner | 5974 Fashion Point Dr Ste 140, South Ogden, UT 84403-4838 | 2019-09-04 |
| 1437706058 | Austin Sumner Heaps | Nurse Practitioner | 1044 N 600 E, Morgan, UT 84050-9269 | 2019-08-19 |
| 1821565839 | Clint Lee Martineau | Nurse Practitioner | 230 N 1680 E # 1, Saint George, UT 84790-2579 | 2018-10-28 |
| 1356827505 | Ashley Smith | Nurse Practitioner | 515 N 600 E, Hyrum, UT 84319-1133 | 2018-07-11 |
| 1588176606 | Bradley Keep | Nurse Practitioner | 4610 W 9980 N, Cedar Hills, UT 84062-8728 | 2017-10-30 |
| 1023548070 | Sarah Leggett | Nurse Practitioner | 9235 S Redwood Rd Ste A, West Jordan, UT 84088-5811 | 2017-06-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.