Healthcare Provider Details

I. General information

NPI: 1407368509
Provider Name (Legal Business Name): KAITLYN WINGET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W. UNIVERSITY PKWY DEPT OF ATHLETICS- MS 104
OREM UT
84058
US

IV. Provider business mailing address

528 N 720 E APT 117
PROVO UT
84606-6975
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-8813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000027491
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: