Healthcare Provider Details

I. General information

NPI: 1821988338
Provider Name (Legal Business Name): KELLY MOTTINGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 N 610 W
VEYO UT
84782-4153
US

IV. Provider business mailing address

459 N 610 W
VEYO UT
84782-4153
US

V. Phone/Fax

Practice location:
  • Phone: 435-817-0117
  • Fax:
Mailing address:
  • Phone: 435-817-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number10270098-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: