Healthcare Provider Details

I. General information

NPI: 1386829992
Provider Name (Legal Business Name): CORY ALAN KARTCHNER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

113 FLAGSHIP DR
SARATOGA SPRINGS UT
84045-3811
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-2401
  • Fax: 801-662-2411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number375584-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: