BRYNNA HADDOCK FNP-C
NPI 1104622158
Nurse Practitioner in Provo, UT
NPI Status: Active since February 20, 2025
Contact Information
1055 N 500 W STE 222
PROVO, UT
ZIP 84604
Phone: (801) 354-8225
Fax: (801) 418-0941
- Individual
- Female
- Years of Experience 3
- Nurse Practitioner
- Accepts Insurance
- May Accept Medicare Approved Payment
- Opted-Out Medicare
About BRYNNA HADDOCK
This page provides the complete NPI Profile along with additional information for Brynna Haddock, a provider established in Provo, Utah with a medical specialization in Nurse Practitioner and more than 3 years of experience. The healthcare provider is registered in the NPI registry with number 1104622158 assigned on February 2025. The practitioner's primary taxonomy code is 363L00000X with license number 14205405-4405 (UT). The provider is registered as an individual and her NPI record was last updated one year ago.
- NPI
- 1104622158
- Provider Name
- BRYNNA HADDOCK FNP-C
- Other Name
- BRYNNA WILSON
- Other Name Type
- Former Name (1)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1055 N 500 W STE 222 PROVO, UT 84604
- Location Phone
- (801) 354-8225
- Location Fax
- (801) 418-0941
- Mailing Address
- 1055 N 500 W ATTN: CREDENTIALING PROVO, UT 84604
- Mailing Phone
- (801) 354-8225
- Mailing Fax
- (801) 418-0941
- Medical School Name
- OTHER
- Graduation Year
- 2024
- Is Sole Proprietor?
- No
- Enumeration Date
- 02-20-2025
- Last Update Date
- 03-07-2025
- Code Navigator
A nurse practitioner (NP) like Brynna Haddock is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Brynna Haddock opted out of Medicare effective on 12-03-2025 until 12-03-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner
- Taxonomy Code
- 363L00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 14205405-4405
- License State
- UT
- Taxonomy Description
- (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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 14205405-4405 (UT) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - HMO
- BridgeSpan Standard Gold Plan - HMO
- BridgeSpan Standard Silver Plan - HMO
- Imperial Preferred Gold - HMO
- Imperial Preferred Silver - HMO
- Imperial Standard Bronze - HMO
- Imperial Standard Gold - HMO
- Imperial Standard Silver - HMO
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Standard - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Molina Silver Saver with Four Free PCP Visits - HMO
- Molina Silver Standard - HMO
- Bronze 8000 - EPO
- Bronze Essential 9000 Deductible With 4 Copay No Deductible Office Visits - EPO
- Bronze HSA 7000 - EPO
- Gold 2300 - EPO
- Regence Standard Bronze 7500 - EPO
- Regence Standard Gold 2000 - EPO
- Regence Standard Silver 6000 - EPO
- Silver 6500 - EPO
- Med Benchmark Expanded Bronze Select Copay Plan - HMO
- Med Benchmark Expanded Bronze Standardized Plan - HMO
- Med Benchmark Gold Standardized Plan - HMO
- Med Benchmark Platinum - HMO
- Med Benchmark Platinum Standardized Plan - HMO
- Med Benchmark Silver 6000 Medical Deductible w/Vision - HMO
- Med Benchmark Silver Standardized Plan - HMO
- Med Gold 1500 Medical Deductible - HMO
- Signature Benchmark Gold - HMO
- Signature Benchmark Gold Standardized Plan - HMO
- Healthy Premier Bronze HSA - EPO
- Healthy Premier Expanded Bronze Standard - EPO
- Healthy Premier Gold Copay Office Visits - EPO
- Healthy Premier Gold Standard - EPO
- Healthy Premier Silver Copay Office Visits - EPO
- Healthy Premier Silver Standard - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Brynna Haddock is registered with Medicare but may not accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 12-03-2025
Opt-Out End Date: 12-03-2027
Eligible to Order and Refer? No
PECOS PAC ID: 7416479274
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20250320003915
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Maybe
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Brynna Haddock is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| UTAH VALLEY HOSPITAL | 1034 NORTH 500 WEST PROVO, UT 84604 | (801) 373-7850 | Acute Care Hospitals | |
| AMERICAN FORK HOSPITAL | 170 NORTH 1100 EAST AMERICAN FORK, UT 84003 | (801) 855-3300 | Acute Care Hospitals | |
| TIMPANOGOS REGIONAL HOSPITAL | 750 WEST 800 NORTH OREM, UT 84057 | (801) 714-6800 | Acute Care Hospitals |
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NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104622158, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 42. The final step is to find the difference between that total and the next multiple of ten (50 - 42 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 42 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 5 providers are registered at the same or a nearby location.
PROVO, UT 84604
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104622158, enumerated as an "individual" on February 20, 2025.
The provider is located at 1055 N 500 W STE 222 PROVO, UT 84604 and the phone number is (801) 354-8225.
Nurse Practitioner with taxonomy code 363L00000X.
The provider might be accepting Accepts: BridgeSpan Health Company, Imperial Health Plan of. Please consult your insurance carrier or call the provider to verify.
Brynna Haddock is affiliated with: UTAH VALLEY HOSPITAL, AMERICAN FORK HOSPITAL and TIMPANOGOS REGIONAL HOSPITAL.
