Healthcare Provider Details

I. General information

NPI: 1487548822
Provider Name (Legal Business Name): KRISTA STEPHENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 1875
OGDEN UT
84403-3325
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-732-5900
  • Fax: 801-732-5989
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12096608-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: