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General NPI Number Information
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NPI Number | 1184481905
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Entity Type | Individual
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Provider Name | KELLY ANDERSON DNP, APRN-CNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1250 E 3900 S STE 260
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1371
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Country | US
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Telephone | 801-265-2000
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Fax | 801-265-2008
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Provider Business Mailing Address
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Address Line | 1250 E 3900 S STE 260
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1371
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Country | US
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Telephone | 801-265-2000
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Fax | 801-265-2008
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10681922-4405
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License Number State | UT
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