Healthcare Provider Details

I. General information

NPI: 1710491048
Provider Name (Legal Business Name): TAYLOR KEVERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 W 700 S STE D
SPRINGVILLE UT
84663-4963
US

IV. Provider business mailing address

1300 E CENTER ST
PROVO UT
84606-3554
US

V. Phone/Fax

Practice location:
  • Phone: 801-489-9721
  • Fax:
Mailing address:
  • Phone: 801-344-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number13575783-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: