Healthcare Provider Details

I. General information

NPI: 1609556596
Provider Name (Legal Business Name): MARY DANIELLE KUYKENDALL PMHNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 3750 S
SOUTH SALT LAKE UT
84115-4428
US

IV. Provider business mailing address

PO BOX 850
OAKLEY UT
84055-0801
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-0911
  • Fax: 801-262-3709
Mailing address:
  • Phone: 801-696-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number77110
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8658127-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: