Healthcare Provider Details

I. General information

NPI: 1083364137
Provider Name (Legal Business Name): KRISTA HENDRICKSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA THURMAN

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 400 N STE 4
OREM UT
84057-1951
US

IV. Provider business mailing address

442 W SALEM CANAL RD
SALEM UT
84653-9231
US

V. Phone/Fax

Practice location:
  • Phone: 801-404-5588
  • Fax:
Mailing address:
  • Phone: 801-234-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number7690389-4402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number7690389
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: