Active NPI
Charles L Head, APRN
- Family Nurse Practitioner
- South Salt Lake, UT
National Provider Identifier
1295423283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 9266563-4405
- Practice address
- 3838 S 700 E Ste 300
South Salt Lake, UT 84106-1496 - Phone
- (801) 261-4988
- NPI assigned
- Apr 27, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9266563-4405 | UT | Primary |
Addresses
Primary practice location
3838 S 700 E Ste 300
South Salt Lake, UT 84106-1496
Mailing address
3838 S 700 E Ste 300
South Salt Lake, UT 84106-1496
Phone (801) 261-4988
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 14, 2025 through Apr 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9266563-4405 | UT | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710979200000",
"number": "1295423283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3838 S 700 E STE 300",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841061496",
"telephone_number": "801-261-4988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3838 S 700 E STE 300",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841061496",
"telephone_number": "801-261-4988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEAD",
"first_name": "CHARLES",
"middle_name": "L",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-27",
"last_updated": "2024-03-21",
"certification_date": "2024-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "9266563-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.