Healthcare Provider Details

I. General information

NPI: 1508498221
Provider Name (Legal Business Name): KIRA SUE WHALEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 S STATE ST
MIDVALE UT
84047-2013
US

IV. Provider business mailing address

4032 W LAUREL RIDGE DR
WEST JORDAN UT
84088-6320
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9400
  • Fax:
Mailing address:
  • Phone: 801-870-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7799011-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7799011-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: