Brynna Haddock, FNP-C is a medicare enrolled "Nurse Practitioner" physician in Provo, Utah. Her current practice location is
1055 N 500 W Ste 222, Provo, Utah. You can reach out to her office (for appointments etc.) via phone at
(801) 354-8225.
Brynna Haddock is licensed to practice in Utah (license number 14205405-4405) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1104622158.
Physician's Profile
| Full Name | Brynna Haddock |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 1055 N 500 W Ste 222, Provo, Utah |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1104622158
- Provider Enumeration Date: 02/20/2025
- Last Update Date: 03/07/2025
Medicare PECOS Information:
- PECOS PAC ID: 7416479274
- Enrollment ID: I20250320003915
Medical Identifiers
Medical identifiers for Brynna Haddock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104622158 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 14205405-4405 (Utah) | Secondary |
| 363L00000X | Nurse Practitioner | 14205405-4405 (Utah) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Brynna Haddock allows following entities to bill medicare on her behalf.
| Entity Name | Central Utah Clinic Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1093764805
PECOS PAC ID: 7517868508
Enrollment ID: O20040113000805 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Brynna Haddock is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Brynna Haddock, FNP-C
1055 N 500 W, Attn: Credentialing,
Provo, UT 84604-3305
Ph: (801) 354-8225 | Brynna Haddock, FNP-C
1055 N 500 W Ste 222,
Provo, UT 84604-3305
Ph: (801) 354-8225 |
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