Healthcare Provider Details

I. General information

NPI: 1407793805
Provider Name (Legal Business Name): VIRTUAL WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 WEST 8780 SOUTH
WEST JORDAN UT
84088
US

IV. Provider business mailing address

1038 WEST 8780 SOUTH
WEST JORDAN UT
84088
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-9168
  • Fax: 801-780-3082
Mailing address:
  • Phone: 801-871-9168
  • Fax: 801-780-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAITLIN CONNOLLY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: DNP
Phone: 801-871-9168