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General NPI Number Information
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NPI Number | 1225828502
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Entity Type | Individual
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Provider Name | KALLIE POTHIER
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Gender | Female
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 08/17/2025
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Provider Practice Location Address
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Address Line | 348 S 2000 W UNIT 18A
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3885
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Country | US
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Telephone | 801-382-8645
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Fax | 866-531-4109
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Provider Business Mailing Address
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Address Line | 1532 W 10 S
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6713
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Country | US
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Telephone | 208-881-4357
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11590992-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 11590992-3102
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License Number State | UT
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