Healthcare Provider Details

I. General information

NPI: 1982131595
Provider Name (Legal Business Name): NICOLE KRISTINE HEWETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE KRISTINE FLORES MD

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 S 2000 E STE 106
SALT LAKE CITY UT
84121-3775
US

IV. Provider business mailing address

9071 S 1300 W STE 205
WEST JORDAN UT
84088-6725
US

V. Phone/Fax

Practice location:
  • Phone: 801-942-1800
  • Fax: 801-944-1865
Mailing address:
  • Phone: 801-453-9625
  • Fax: 801-944-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME150803
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13944363-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: