Healthcare Provider Details

I. General information

NPI: 1275467250
Provider Name (Legal Business Name): KEITH BROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3784 W VALLEY VIEW DR
CEDAR HILLS UT
84062-8085
US

IV. Provider business mailing address

2627 DESERT RD
MOAB UT
84532-3401
US

V. Phone/Fax

Practice location:
  • Phone: 435-260-0032
  • Fax:
Mailing address:
  • Phone: 435-260-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF26-160838
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: