Healthcare Provider Details

I. General information

NPI: 1568344695
Provider Name (Legal Business Name): ELISABETH KENT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N MAIN ST
LEWISTON UT
84320-1521
US

IV. Provider business mailing address

79 N MAIN ST
LEWISTON UT
84320-1521
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-9729
  • Fax:
Mailing address:
  • Phone: 435-760-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8871537-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: