Healthcare Provider Details

I. General information

NPI: 1912383498
Provider Name (Legal Business Name): KRYSTAL KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N HOSPITAL DR STE 5
PRICE UT
84501-4211
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE STE 260
PROVO UT
84604-6683
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4590
  • Fax: 435-637-4598
Mailing address:
  • Phone: 801-374-9625
  • Fax: 801-374-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1613A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5530782-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: