Provider Demographics
NPI:1568191088
Name:MANSFIELD, AUSTIN
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S DEEP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3479
Mailing Address - Country:US
Mailing Address - Phone:801-900-1297
Mailing Address - Fax:435-355-3794
Practice Address - Street 1:518 S DEEP CREEK DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3479
Practice Address - Country:US
Practice Address - Phone:018-900-1297
Practice Address - Fax:435-355-3794
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0102656363LP0808X
CO0104009363LP0808X
NV856732363LP0808X
FL2777363LP0808X
UT10666184-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health