=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851152292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTA M MARTINEZ FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2024
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 N 500 W STE 201
-----------------------------------------------------
City | PROVO
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84604-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-429-8000
-----------------------------------------------------
Fax | 801-429-8150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 N 500 W ATT CREDENTIALING
-----------------------------------------------------
City | PROVO
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84604-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-203-2741
-----------------------------------------------------
Fax | 801-418-0844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9897745-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------