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NPI Code Detail

MEDICARE: KJERSTEN NELSON

MEDICARE: KJERSTEN NELSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184473217
Entity Type Code : Individual
Provider Name (Legal Business Name) : KJERSTEN NELSON
Provider Business Mailing Address
First Line : 2825 E COTTONWOOD PKWY STE 500
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-7060
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2825 E COTTONWOOD PKWY STE 500
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-7060
Country : US
Telephone Number : 801-653-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 05/13/2024

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