Healthcare Provider Details

I. General information

NPI: 1982511051
Provider Name (Legal Business Name): KERRY BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S 900 E STE 203-D
ST GEORGE UT
84790-7000
US

IV. Provider business mailing address

1345 E MOUNTAIN RIDGE DR
WASHINGTON UT
84780-3463
US

V. Phone/Fax

Practice location:
  • Phone: 435-236-3177
  • Fax:
Mailing address:
  • Phone: 435-236-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14224082-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: