Active NPI
Cammi Jo Fruin, AGNP-C
- Nurse Practitioner
- Heber City, UT
National Provider Identifier
1275127490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 341638-4405
- Practice address
- 450 W 910 S Ste 203
Heber City, UT 84032-2447 - Phone
- (801) 712-0994
- Fax
- (888) 807-7464
- NPI assigned
- Feb 28, 2021
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 341638-4405 | UT | |
| Nurse Practitioner | 363L00000X | 341638-4405 | UT | Primary |
Addresses
Primary practice location
450 W 910 S Ste 203
Heber City, UT 84032-2447
Mailing address
1144 N 455 W Unit 6
Midway, UT 84049-6493
Phone (801) 712-0994
Other practice location 1
1055 N 500 W Ste 202
Provo, UT 84604-3305
Phone (801) 374-2367
Other practice location 2
1175 E 50 S Ste 171
American Fork, UT 84003-2845
Phone (801) 772-0698
Other practice location 3
96 E Kimballs Ln Ste 305
Draper, UT 84020-5021
Phone (801) 655-5670
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Provo | Health Information Exchange (HIE) | |
| Direct Messaging Address | medreview@reverehealth.com | Central Utah Clinic, P.C. | |
| CONNECT URL | synergyhealthandwellnessllc@gmail.com | Health Information Exchange (HIE) |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 341638-4405 | UT | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650931200000",
"number": "1275127490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1144 N 455 W UNIT 6",
"city": "MIDWAY",
"state": "UT",
"postal_code": "840496493",
"telephone_number": "801-712-0994",
"fax_number": "888-807-7464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 W 910 S STE 203",
"city": "HEBER CITY",
"state": "UT",
"postal_code": "840322447",
"telephone_number": "801-712-0994",
"fax_number": "888-807-7464"
}
],
"practiceLocations": [
{
"address_1": "1055 N 500 W Ste 202",
"address_purpose": "LOCATION",
"city": "Provo",
"state": "UT",
"postal_code": "846043305",
"country_code": "US",
"telephone_number": "801-374-2367",
"fax_number": "801-429-8015",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1175 E 50 S Ste 171",
"address_purpose": "LOCATION",
"city": "American Fork",
"state": "UT",
"postal_code": "840032845",
"country_code": "US",
"telephone_number": "801-772-0698",
"fax_number": "801-772-0705",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "96 E Kimballs Ln Ste 305",
"address_purpose": "LOCATION",
"city": "Draper",
"state": "UT",
"postal_code": "840205021",
"country_code": "US",
"telephone_number": "801-655-5670",
"fax_number": "385-203-1344",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FRUIN",
"first_name": "CAMMI",
"middle_name": "JO",
"credential": "AGNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-28",
"last_updated": "2022-04-26",
"certification_date": "2022-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "UT",
"license": "341638-4405",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "UT",
"license": "341638-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Provo",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1055 N 500 W # 202",
"city": "Provo",
"state": "UT",
"country_code": "US",
"postal_code": "846043305",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "medreview@reverehealth.com",
"affiliation": "Y",
"affiliationName": "Central Utah Clinic, P.C.",
"address_1": "1055 N 500 W # 202",
"city": "Provo",
"state": "UT",
"country_code": "US",
"postal_code": "846043305",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "synergyhealthandwellnessllc@gmail.com",
"affiliation": "N",
"endpointDescription": "Synergy Health and Wellness",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "450 W 910 S Ste 203",
"city": "Heber City",
"state": "UT",
"country_code": "US",
"postal_code": "840322447",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Heber City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.