Healthcare Provider Details

I. General information

NPI: 1699632430
Provider Name (Legal Business Name): JANUARY KINGSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 W 12600 S
RIVERTON UT
84096-7401
US

IV. Provider business mailing address

4019 W 12600 S
RIVERTON UT
84096-7401
US

V. Phone/Fax

Practice location:
  • Phone: 801-904-2488
  • Fax:
Mailing address:
  • Phone: 801-904-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12097073-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: