Healthcare Provider Details

I. General information

NPI: 1184954554
Provider Name (Legal Business Name): KENNETH MONEY, CRNA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 1240 S
SPANISH FORK UT
84660-2989
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-2640
  • Fax: 801-432-2668
Mailing address:
  • Phone: 801-432-2640
  • Fax: 801-432-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number206282-4406
License Number StateUT

VIII. Authorized Official

Name: MR. KENNETH A. MONEY
Title or Position: OWNER/ PRESIDENT
Credential: CRNA
Phone: 801-798-8755