Healthcare Provider Details

I. General information

NPI: 1457215519
Provider Name (Legal Business Name): ELESSAR PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W 2710 SOUTH CIR STE 202A
ST GEORGE UT
84790-7205
US

IV. Provider business mailing address

169 W 2710 SOUTH CIR STE 202A
ST GEORGE UT
84790-7205
US

V. Phone/Fax

Practice location:
  • Phone: 720-664-9877
  • Fax: 888-350-9528
Mailing address:
  • Phone: 720-664-9877
  • Fax: 888-350-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KATY ALDERMAN
Title or Position: OWNER/PROVIDER
Credential: MSN, PMHNP-BC
Phone: 720-664-9877