Healthcare Provider Details

I. General information

NPI: 1649338856
Provider Name (Legal Business Name): KELLEIGH JEAN STRICKLAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 1500 S STE 201
BOUNTIFUL UT
84010-7434
US

IV. Provider business mailing address

623 N MILLEDGE AVE UNIT A
ATHENS GA
30601-3803
US

V. Phone/Fax

Practice location:
  • Phone: 844-209-5258
  • Fax:
Mailing address:
  • Phone: 770-965-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN146690
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR45240
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP5610
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: