Healthcare Provider Details

I. General information

NPI: 1003678525
Provider Name (Legal Business Name): KATIE STOKES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E 3900 S STE 340
SLC UT
84124-1244
US

IV. Provider business mailing address

PO BOX 742382
ATLANTA GA
30374-2382
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-7479
  • Fax: 801-268-7622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8030718-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: