Healthcare Provider Details

I. General information

NPI: 1033048194
Provider Name (Legal Business Name): KRISTIE LEIGH ALLRED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W STATE RD STE 103
PLEASANT GROVE UT
84062-2158
US

IV. Provider business mailing address

1154 E 30 S
PLEASANT GROVE UT
84062-2598
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-4368
  • Fax:
Mailing address:
  • Phone: 801-400-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11773880-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: