Active NPI
Brynna Haddock, FNP-C
- Nurse Practitioner
- Provo, UT
National Provider Identifier
1104622158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 14205405-4405
- Practice address
- 1055 N 500 W Ste 222
Provo, UT 84604-3305 - Phone
- (801) 354-8225
- Fax
- (801) 418-0941
- NPI assigned
- Feb 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14205405-4405 | UT | |
| Nurse Practitioner | 363L00000X | 14205405-4405 | UT | Primary |
Addresses
Primary practice location
1055 N 500 W Ste 222
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other names 1
- Brynna Wilson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 3, 2025 through Dec 3, 2027
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1055 N 500
Provo, UT 84604-3305
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14205405-4405 | UT | MD | Family Medicine Physician |
Interoperability endpoints
- brynnahaddock@cuccu.allscriptsdirect.net
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Provo, UT
- NPI 1114025491
-
- General Acute Care Hospital
- American Fork, UT
- NPI 1912014358
-
- General Acute Care Hospital
- Orem, UT
- NPI 1497702195
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1740009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741305600000",
"number": "1104622158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "ATTN: CREDENTIALING",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N 500 W STE 222",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOCK",
"first_name": "BRYNNA",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-20",
"last_updated": "2025-03-07",
"certification_date": "2025-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "UT",
"license": "14205405-4405",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "UT",
"license": "14205405-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRYNNA",
"last_name": "WILSON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.