Healthcare Provider Details

I. General information

NPI: 1114839289
Provider Name (Legal Business Name): TAYLOR NICOLE KEYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

IV. Provider business mailing address

3144 S 1885 E
SALT LAKE CITY UT
84106-3957
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3414
  • Fax:
Mailing address:
  • Phone: 907-978-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: