| Doctor Name: | MR. TODD L CHIDESTER |
| NPI Number: | 1154383305 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 195992-8900 |
| Business Practice Address: | 1159 E 200 N Suite 200 American Fork, UT - 84003 |
| Business Phone Number: | 8017565290 |
| Business Fax Number: | 8017565200 |
| Mailing Address: | 1159 E 200 N Suite 200, AMERICAN FORK |
| State: | UT |
| Postal Code: | 84003 |
| Phone Number: | 8017565290 |
| Fax Number: | 8017565200 |
| NPI Enumeration Date: | 04/04/2006 |
| NPI Last Update Date: | 01/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 195992-8900 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |