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General NPI Number Information
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NPI Number | 1679324776
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Entity Type | Individual
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Provider Name | KELLY ELAINE HANSEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1327 S INTERSTATE DR STE B
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City | CEDAR CITY
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State | UT
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Zip | 84720-1258
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Country | US
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Telephone | 435-590-3471
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Fax | 435-921-6620
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Provider Business Mailing Address
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Address Line | 871 E FIDDLERS CANYON RD
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City | CEDAR CITY
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State | UT
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Zip | 84721-7704
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Country | US
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Telephone | 435-590-3471
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9800937-4405
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License Number State | UT
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