MEDICARE: KATHLEEN SHERRIE RICH

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	363L00000X	Nurse Practitioner	4885433-8900	UT
2	363LF0000X	Family Nurse Practitioner	4885433-8900	UT

General Provider Information

NPI Number	:	1588236442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SHERRIE RICH

Provider Business Mailing Address
First Line	:	PO BOX 198560
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 E 4500 S STE 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-8535
Country	:	US
Telephone Number	:	801-266-2777
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	01/29/2024

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Directions to “ KATHLEEN SHERRIE RICH ” Practice Location

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