Healthcare Provider Details

I. General information

NPI: 1770853558
Provider Name (Legal Business Name): KRISTIN KAY BRADBURY-KRISTENSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-4183
  • Fax:
Mailing address:
  • Phone: 801-662-4183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number327855-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number327855-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: