Healthcare Provider Details

I. General information

NPI: 1790152973
Provider Name (Legal Business Name): KRISTY MARTIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S 5600 W
WEST VALLEY CITY UT
84120-1249
US

IV. Provider business mailing address

1758 S LAURELHURST DR
SALT LAKE CITY UT
84108-3310
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-5732
  • Fax:
Mailing address:
  • Phone: 978-457-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9484112-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9484112-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: