Healthcare Provider Details

I. General information

NPI: 1144650664
Provider Name (Legal Business Name): JAMES KEVIN VISKER AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 W TRAVERSE PKWY STE E510
LEHI UT
84043-5986
US

IV. Provider business mailing address

1881 W TRAVERSE PKWY STE E510
LEHI UT
84043-5986
US

V. Phone/Fax

Practice location:
  • Phone: 385-434-1141
  • Fax: 801-335-5125
Mailing address:
  • Phone: 385-434-1141
  • Fax: 801-434-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264688-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number264688-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number264688-4405
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number264688-4405
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number264688-44059
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: