Healthcare Provider Details

I. General information

NPI: 1396552188
Provider Name (Legal Business Name): KAISLEY NAN CHRISTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 S STATE ST STE 320
DRAPER UT
84020-7166
US

IV. Provider business mailing address

11762 S STATE ST STE 320
DRAPER UT
84020-7166
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-3894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12324627-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12324627-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: