Healthcare Provider Details

I. General information

NPI: 1780395418
Provider Name (Legal Business Name): KYLEE A BECKSTROM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLEE A MCKELLAR RN

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST STE 520
MURRAY UT
84107-6756
US

IV. Provider business mailing address

5265 W BLUEBONNET CIR
WEST JORDAN UT
84081-5364
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108082544405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: