Healthcare Provider Details

I. General information

NPI: 1457069635
Provider Name (Legal Business Name): KELSEY N FURR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9069 S 1300 W
WEST JORDAN UT
84088-6713
US

IV. Provider business mailing address

408 N SEA CHASER LN
SARATOGA SPRINGS UT
84045-5575
US

V. Phone/Fax

Practice location:
  • Phone: 801-483-1600
  • Fax:
Mailing address:
  • Phone: 916-365-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9029014-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9029014-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: