Healthcare Provider Details

I. General information

NPI: 1528642139
Provider Name (Legal Business Name): KRISTINA K BENNETT DNP, FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MAIN ST STE 101
BOUNTIFUL UT
84010-6134
US

IV. Provider business mailing address

701 RIDGE TOP CIR
NORTH SALT LAKE UT
84054-2816
US

V. Phone/Fax

Practice location:
  • Phone: 801-874-2388
  • Fax:
Mailing address:
  • Phone: 801-815-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number308224-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: