Healthcare Provider Details

I. General information

NPI: 1932629946
Provider Name (Legal Business Name): KACIE DOYLE-DELGADO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 S 1300 E
SANDY UT
84094-3763
US

IV. Provider business mailing address

2262 E 4160 S
HOLLADAY UT
84124-3400
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8644351-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8644351-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: