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General NPI Number Information
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NPI Number | 1013721687
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Entity Type | Individual
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Provider Name | KATELYN JANAE HARRISON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3556 W 9800 S STE 101
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-3221
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Country | US
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Telephone | 801-567-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 297 N 760 W
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City | OREM
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State | UT
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Zip | 84057-4516
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Country | US
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Telephone | 435-313-0778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 11101272-3102
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11101272-8900
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License Number State | UT
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