Healthcare Provider Details

I. General information

NPI: 1851109417
Provider Name (Legal Business Name): KASSIDEE CANDICE TAPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 09/25/2026
Certification Date: 12/27/2024
Deactivation Date: 11/07/2025
Reactivation Date: 09/25/2026

III. Provider practice location address

1726 S BUCKLEY LN
PROVO UT
84606-5031
US

IV. Provider business mailing address

857 E 200 S
SALT LAKE CITY UT
84102-2317
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-6562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: