Healthcare Provider Details

I. General information

NPI: 1861615296
Provider Name (Legal Business Name): KELLI L PARKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 300
AMERICAN FORK UT
84003-2956
US

IV. Provider business mailing address

1248 E 90 N STE 300
AMERICAN FORK UT
84003-2956
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9635
  • Fax: 801-216-8357
Mailing address:
  • Phone: 801-756-9635
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number183463-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: