Healthcare Provider Details

I. General information

NPI: 1982131595
Provider Name (Legal Business Name): NICOLE KRISTINE HEWETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE KRISTINE FLORES MD

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 S 3200 W
TAYLORSVILLE UT
84129-2822
US

IV. Provider business mailing address

1455 W 2200 S STE 300
WEST VALLEY CITY UT
84119-7219
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-6214
  • Fax: 877-497-4661
Mailing address:
  • Phone: 801-412-6920
  • Fax: 877-497-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13944363-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME150803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: