Healthcare Provider Details

I. General information

NPI: 1013721687
Provider Name (Legal Business Name): KATELYN JANAE HARRISON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN JANAE MORALES LLAN

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

IV. Provider business mailing address

297 N 760 W
OREM UT
84057-4516
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax:
Mailing address:
  • Phone: 435-313-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11101272-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11101272-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: