Healthcare Provider Details

I. General information

NPI: 1326475476
Provider Name (Legal Business Name): KURTIS RUSSELL SMITH F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 N 1700 W SUITE C
LAYTON UT
84041-1164
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-8644
  • Fax: 801-927-1591
Mailing address:
  • Phone: 801-442-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6216136-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6216136-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: