Individual provider Active NPI

Grace Ann Patterson

  • Community Health Worker
  • Bountiful, UT
National Provider Identifier
1104666965
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
415 Medical Dr Ste A100
Bountiful, UT 84010-4995
Phone
(801) 683-1062
NPI assigned
May 29, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

415 Medical Dr Ste A100
Bountiful, UT 84010-4995

Mailing address

415 Medical Dr Ste A100
Bountiful, UT 84010-4995
Phone (801) 683-1062

Other practice location 1

117 W 400 S
Salt Lake City, UT 84101-1916
Phone (801) 428-4257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1104666965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE A100",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104995",
            "telephone_number": "801-683-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE A100",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104995",
            "telephone_number": "801-683-1062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 W 400 S",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841011916",
            "country_code": "US",
            "telephone_number": "801-428-4257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "GRACE",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-29",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.