Healthcare Provider Details

I. General information

NPI: 1891248233
Provider Name (Legal Business Name): KELLY HOOTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 N 420 W
SANTAQUIN UT
84655-5112
US

IV. Provider business mailing address

716 N 420 W
SANTAQUIN UT
84655-5112
US

V. Phone/Fax

Practice location:
  • Phone: 801-404-9893
  • Fax:
Mailing address:
  • Phone: 801-404-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4995783-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: