Healthcare Provider Details

I. General information

NPI: 1992684062
Provider Name (Legal Business Name): KEVIN SHORTEN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 S 3750 E
SPANISH FORK UT
84660-6398
US

IV. Provider business mailing address

1385 S 3750 E
SPANISH FORK UT
84660-6398
US

V. Phone/Fax

Practice location:
  • Phone: 801-831-1573
  • Fax:
Mailing address:
  • Phone: 801-831-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12957350-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12957350-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: