Active NPI
Vicky Suruky
- Family Nurse Practitioner
- Provo, UT
National Provider Identifier
1851934707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 8792215-4405
- Practice address
- 4501 N University Ave
Provo, UT 84604-5504 - Phone
- (888) 676-7104
- NPI assigned
- Oct 23, 2019
- 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 8792215-3102 | UT | |
| Family Nurse Practitioner | 363LF0000X | 8792215-4405 | UT | Primary |
Addresses
Primary practice location
4501 N University Ave
Provo, UT 84604-5504
Mailing address
4501 N University Ave
Provo, UT 84604-5504
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8792215-3102 | UT | MD | Psychiatric/Mental Health Registered Nurse |
| 8792215-4405 | UT | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1851934707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 N UNIVERSITY AVE",
"city": "PROVO",
"state": "UT",
"postal_code": "846045504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 N UNIVERSITY AVE",
"city": "PROVO",
"state": "UT",
"postal_code": "846045504",
"telephone_number": "888-676-7104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURUKY",
"first_name": "VICKY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-23",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "UT",
"license": "8792215-3102",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "8792215-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.