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NPI Code Detail

MEDICARE: KATHERINE NELSON BLACKHAM FNP-C

MEDICARE: KATHERINE NELSON BLACKHAM 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
1363LF0000XFamily Nurse Practitioner11581803-4405UT

General Provider Information

NPI Number : 1457031429
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE NELSON BLACKHAM FNP-C
Provider Business Mailing Address
First Line : 2051 E SANDS DR
Second Line :
City : HOLLADAY
State : UT
Zip : 84124-2727
Country : US
Telephone Number : 435-632-3637
Fax Number :
Provider Business Practice Location Address
First Line : 1446 W PLEASANT GROVE BLVD
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-3216
Country : US
Telephone Number : 801-785-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 07/25/2023

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Directions to “ KATHERINE NELSON BLACKHAM FNP-C” Practice Location

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