Healthcare Provider Details

I. General information

NPI: 1205730900
Provider Name (Legal Business Name): KYLE IKAIKA KELIIPULEOLE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W 950 N
LAYTON UT
84041-7111
US

IV. Provider business mailing address

1035 W 950 N
LAYTON UT
84041-7111
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-2835
  • Fax:
Mailing address:
  • Phone: 801-589-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13014714-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: