Healthcare Provider Details

I. General information

NPI: 1457200735
Provider Name (Legal Business Name): ALEXANDER JOHN KALKE AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX KALKE AGACNP

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUND VALLEY DR STE 100
PARK CITY UT
84060-7552
US

IV. Provider business mailing address

108 W 350 S
MIDWAY UT
84049-6509
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-6600
  • Fax:
Mailing address:
  • Phone: 734-260-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10668638-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10668638-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: