Healthcare Provider Details

I. General information

NPI: 1316718968
Provider Name (Legal Business Name): KIMBERLIE KEYSER YADON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W 12600 S
RIVERTON UT
84065-7070
US

IV. Provider business mailing address

3544 W VIA BELLO CT
SOUTH JORDAN UT
84095-8152
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-4600
  • Fax:
Mailing address:
  • Phone: 801-573-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number308855-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: