=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144650664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES KEVIN VISKER AGPCNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2013
-----------------------------------------------------
Last Update Date | 11/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1881 W TRAVERSE PKWY STE E510
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-5986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-434-1141
-----------------------------------------------------
Fax | 801-335-5125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1881 W TRAVERSE PKWY STE E510
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-5986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-434-1141
-----------------------------------------------------
Fax | 801-434-1141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 264688-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 264688-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 264688-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 264688-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 264688-44059
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------