Healthcare Provider Details

I. General information

NPI: 1245688175
Provider Name (Legal Business Name): KRISTEN BIKHAZI WOODY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N WYMOUNT TERRACE DR
PROVO UT
84602-1017
US

IV. Provider business mailing address

1750 N WYMOUNT TERRACE DR
PROVO UT
84602-1017
US

V. Phone/Fax

Practice location:
  • Phone: 801-422-5156
  • Fax: 801-422-0761
Mailing address:
  • Phone: 801-422-5156
  • Fax: 801-422-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14298702-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2662
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: