Individual provider Active NPI

Maddison J Peterson

  • Obstetrics & Gynecology Nurse Practitioner
  • Layton, UT
National Provider Identifier
1427922186
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
F09251161 Issued in UT
Practice address
1756 W Antelope Dr
Layton, UT 84041-1143
Phone
(801) 773-4840
NPI assigned
Oct 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X F09251161 UT Primary

Addresses

Primary practice location

1756 W Antelope Dr
Layton, UT 84041-1143

Mailing address

2028 S 4140 W
Ogden, UT 84401-6000
Phone (801) 695-7670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251229000940 UT Practitioner - Nurse Practitioner 2264928381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

1756 W Antelope Dr
Layton, UT 84041-1143
Phone (801) 525-8726

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F09251161UTMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic CurrentSince Nov 1, 2025 Accepting new patients
Tanner Memorial Clinic CurrentSince Nov 1, 2025 Accepting new patients
Tanner Memorial Clinic PastSince Oct 5, 2025 Accepting new patients

Locations

1756 W Antelope Dr
Layton, UT 84041
Phone (801) 525-8726

425 S 100 W
Layton, UT 84041
Phone (801) 682-8708

Interoperability endpoints

  • Direct secure messaging: maddison.peterson.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1759449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1427922186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 S 4140 W",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844016000",
            "telephone_number": "801-695-7670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 W ANTELOPE DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411143",
            "telephone_number": "801-773-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MADDISON",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-03",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "UT",
            "license": "F09251161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

Verify at the official NPI Registry.