Healthcare Provider Details

I. General information

NPI: 1326622689
Provider Name (Legal Business Name): KATHLEEN MITCHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 W WIDE HOLLOW DR
HERRIMAN UT
84096-3550
US

IV. Provider business mailing address

6626 W WIDE HOLLOW DR
HERRIMAN UT
84096-3550
US

V. Phone/Fax

Practice location:
  • Phone: 801-885-2264
  • Fax:
Mailing address:
  • Phone: 801-885-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7249521-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number7249521-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: