BRYNNA HADDOCK FNP-C
NPI 1104622158
Nurse Practitioner in Provo, UT

Q: What is Brynna Haddock's NPI number?

The NPI number for Brynna Haddock is 1104622158. It was assigned to this individual provider in the NPPES registry on February 20, 2025. The provider is also known as Brynna Wilson.

Q: What is Brynna Haddock's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: Is Brynna Haddock enrolled in Medicare?

No. Brynna Haddock has opted out of Medicare through December 3, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Brynna Haddock was last updated on March 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 20, 2025Opted out of Medicare · through Dec 3, 2027

1055 N 500 W STE 222, PROVO, UT 84604(801) 354-8225(801) 418-0941 Get Directions Write a Review

NPPES record last updated: March 7, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 7, 2025, Feb 20, 2025 (2 updates tracked since 2025).

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About Brynna Haddock Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRYNNA HADDOCK FNP-C (NPI 1104622158) is an individual nurse practitioner in Provo, Utah, licensed in Utah (14205405-4405) and active in the NPI registry since February 2025. She has opted out of Medicare through December 3, 2027, is affiliated with Utah Valley Hospital, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1104622158

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameBRYNNA HADDOCKCredential: FNP-C

Location Address1055 N 500 W STE 222Provo, UT 84604-3305

Mailing Address1055 N 500 W, Attn: CredentialingProvo, UT 84604-3305 · (801) 354-8225 · Fax (801) 418-0941

Phone(801) 354-8225

Fax(801) 418-0941

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateFebruary 20, 2025

Last NPPES UpdateMarch 7, 20252 updates tracked since enumeration

NPPES CertifiedMarch 7, 2025

✔ NPI 1104622158 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in UT · 14205405-4405

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedFamily MedicineTaxonomy 207Q00000X · License 14205405-4405 (UT)

1055 N 500 W STE 222, Provo, UT 84604

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Other Names 1

Former Name (1)Brynna Wilson

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Imperial Health Plan of the Southwest, Inc., Molina Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Brynna Haddock Fnp-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 3, 2025 through December 3, 2027.

Opt-Out Effective DateDecember 3, 2025

Opt-Out In Effect ThroughDecember 3, 2027Opt-out affidavits renew automatically every two years unless cancelled

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Utah Valley Hospital

Acute Care Hospitals · Provo, UT

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number460001

Location1034 North 500 WestProvo, UT 84604 · Utah County

Emergency services Birthing friendly

American Fork Hospital

Acute Care Hospitals · American Fork, UT

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number460023

Location170 North 1100 EastAmerican Fork, UT 84003 · Utah County

Emergency services Birthing friendly

Timpanogos Regional Hospital

Acute Care Hospitals · Orem, UT

3/5 CMS rating

OwnershipProprietary

CMS Certification Number460052

Location750 West 800 NorthOrem, UT 84057 · Utah County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VENUS VELEZ FNP-C

Nurse Practitioner (Family)