Healthcare Provider Details

I. General information

NPI: 1306504246
Provider Name (Legal Business Name): KAYLA OLSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 EAST 100 NORTH
GUNNISON UT
84634
US

IV. Provider business mailing address

HC 64 BOX 21064
AXTELL UT
84621-5504
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-2222
  • Fax:
Mailing address:
  • Phone: 435-528-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9057872-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: