Healthcare Provider Details

I. General information

NPI: 1588309652
Provider Name (Legal Business Name): KALLIE HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

4637 CHABOT DR STE 104
PLEASANTON CA
94588-2749
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4800
  • Fax:
Mailing address:
  • Phone: 925-251-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14220308-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: