Healthcare Provider Details

I. General information

NPI: 1699631762
Provider Name (Legal Business Name): SPENCER KENDALL ALLAN RN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1300 E CENTER ST
PROVO UT
84606-3554
US

IV. Provider business mailing address

118 N MAPLE BEND DR
SPANISH FORK UT
84660-6214
US

V. Phone/Fax

Practice location:
  • Phone: 801-344-4400
  • Fax:
Mailing address:
  • Phone: 385-477-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number10662470-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: