MEDICARE: KAYLENE ELDER FNP-C

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
1	363LF0000X	Family Nurse Practitioner	11361127-4405	UT

General Provider Information

NPI Number	:	1265821276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLENE ELDER FNP-C

Provider Business Mailing Address
First Line	:	652 S MEDICAL CENTER DR STE 110
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-7077
Country	:	US
Telephone Number	:	435-215-0230
Fax Number	:	435-986-7092

Provider Business Practice Location Address
First Line	:	320 RIVER PARK DR STE 255
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	385-203-0246
Fax Number	:	385-203-0245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	05/06/2020

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