Healthcare Provider Details

I. General information

NPI: 1962320127
Provider Name (Legal Business Name): SEAN KERRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEAN PATRIK KERRY

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: