Healthcare Provider Details

I. General information

NPI: 1972410108
Provider Name (Legal Business Name): KELLI DAWN PEARSON CASE MANAGEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 W DURFEE ST
GRANTSVILLE UT
84029-9627
US

IV. Provider business mailing address

185 W DURFEE ST
GRANTSVILLE UT
84029-9627
US

V. Phone/Fax

Practice location:
  • Phone: 801-819-2408
  • Fax:
Mailing address:
  • Phone: 801-819-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF26-174378
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: