Hailey Russell, DNP, FNP
Individual provider Active NPI Family Nurse Practitioner · Clinton, UT
NPI 1104587864 · NPPES record last updated Feb 10, 2022
Key facts
- NPI
- 1104587864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 9771200-4405 (UT)
- Practice address
- 1477 N 2000 W
Clinton, UT 84015-8638 - Phone
- (801) 773-4840
- NPI assigned
- Jan 5, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Tanner Memorial Clinic
Practice addresses (Care Compare)
1477 N 2000
Suite C
Clinton, UT 84015-9099
Phone (801) 773-4840
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220218000677 | UT | Practitioner - Nurse Practitioner | 1153715073 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9771200-4405 | UT | MD | Family Nurse Practitioner |
| 9771200-8900 | UT | MD | Family Nurse Practitioner |
Practice roles (3 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanner Memorial Clinic | Current |
Accepting new patients | |
| Tanner Memorial Clinic | Current |
Accepting new patients | |
| Tanner Memorial Clinic | Current | Accepting new patients |
Locations
1477 N 2000 W
Ste C
Clinton, UT 84015
Phone (801) 546-9441
1477 N 2000 W
Clinton, UT 84015
Phone (801) 774-8888
1756 W Antelope Dr
Layton, UT 84041
Phone (801) 525-8726
425 S 100 W
Layton, UT 84041
Phone (801) 682-8708
Networks
- UT PPO D-SNP
- UT PPO
Interoperability endpoints
- hailey.russell.p1@direct.tannerclinic.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9771200-8900 | UT | |
| Family Nurse Practitioner | 363LF0000X | 9771200-4405 | UT | Yes |
Addresses
Primary practice location
1477 N 2000 W
Clinton, UT 84015-8638
Mailing address
PO Box 337
Layton, UT 84041-0337
Phone (801) 773-4840
Other providers in Clinton, UT
- Kilee Danielle Robinson
- Roe RX Inc
- John Lee Roring
- Allen Rose
- Dennis C Roseth
- Emily Ann Salisbury
- Vanessa Rae Sanders
- Welford G Sanford Jr.
- Barbara Anne Scarbrough
- Kristin Schade
All providers in Clinton, UT · Family Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.