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General NPI Number Information
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NPI Number | 1205507951
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Entity Type | Individual
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Provider Name | MELISSA KEITH
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Gender | Female
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 97 PROFESSIONAL WAY STE 2
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City | PAYSON
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State | UT
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Zip | 84651-1680
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Country | US
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Telephone | 801-465-4896
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Fax | 801-465-4107
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Provider Business Mailing Address
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Address Line | 1055 N 500 W ATT CREDENTIALING
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City | PROVO
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State | UT
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Zip | 84604
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Country | US
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Telephone | 801-354-8225
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Fax | 801-418-0941
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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 | 281902-4405
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License Number State | UT
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