Healthcare Provider Details

I. General information

NPI: 1659641868
Provider Name (Legal Business Name): KELSON PHYSIJCIAN PARTNERS OF LAYTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 SOUTH MIDLAND DR SUITE 2
ROY UT
84067
US

IV. Provider business mailing address

2086 N 1700 W SUITE C
LAYTON UT
84041
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-8644
  • Fax: 801-927-1591
Mailing address:
  • Phone: 801-773-8644
  • Fax: 801-927-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MATT WEST
Title or Position: COO/ADMINISTRATOR
Credential:
Phone: 801-927-1571