Healthcare Provider Details

I. General information

NPI: 1548752827
Provider Name (Legal Business Name): KELSIE J ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 10/16/2021
Certification Date: 10/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

1615 LAKEVIEW WAY
OGDEN UT
84403-1416
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7000
  • Fax:
Mailing address:
  • Phone: 801-928-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5900300-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: