Healthcare Provider Details

I. General information

NPI: 1992828958
Provider Name (Legal Business Name): KAYLEEN TERRY A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 S HIGHLAND DR STE 110
SANDY UT
84093-7403
US

IV. Provider business mailing address

2223 E VALDE NEIGE CIR
SANDY UT
84093-1073
US

V. Phone/Fax

Practice location:
  • Phone: 801-707-7004
  • Fax:
Mailing address:
  • Phone: 801-707-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number150335-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number150335-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: