Healthcare Provider Details

I. General information

NPI: 1053145318
Provider Name (Legal Business Name): AURORA KATHERINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5286 W 5725 S
HOOPER UT
84315
US

IV. Provider business mailing address

2811 N 2350 W
FARR WEST UT
84404-5177
US

V. Phone/Fax

Practice location:
  • Phone: 801-889-8809
  • Fax:
Mailing address:
  • Phone: 801-872-8757
  • Fax: 801-872-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: