Shalise Hali Owens

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

8642517-4405 Issued in UT

Practice address

320 W 500 S Ste 210
Bountiful, UT 84010-7254

Phone

(801) 797-9121

NPI assigned

Jun 26, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

University of Utah School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rocky Mountain Dermatology IncGroup PAC ID 6002992906, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Rocky Mountain Dermatology Inc

  • Dermatology Physician
  • North Logan, UT
  • NPI 1154527372
  Medicare reassignment Care Compare group NPD
• Legacy Dermatology

  • Medical Specialty Clinic/Center
  • Bountiful, UT
  • NPI 1376944942
  Medicare reassignment NPD

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1821583519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 W 500 S STE 210",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107254",
            "telephone_number": "801-797-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 W 500 S STE 210",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107254",
            "telephone_number": "801-797-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWENS",
        "first_name": "SHALISE",
        "middle_name": "HALI",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "8642517-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Oslund
• David B Osteyee
• Outdoor Talk LLC
• Jami Lynne Oviatt, NP
• Lyndie K Oviatt
• Daniel Wayne Pace, O.D
• Pacific Footwear Company, Inc. (Priority Footwear & Pedorthic Services)
• Christine M Packard, PA-C
• Page Family Dentistry LLC
• Robert F Page, DDS

• Family Nurse Practitioner in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.
• 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.

Verify at the official NPI Registry.