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NPI Code Detail

MEDICARE: KATHRYN L. FORNERIS DO

MEDICARE: KATHRYN L. FORNERIS DO
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
12084P0800XPsychiatry Physician13521387-1204UT

General Provider Information

NPI Number : 1669113957
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN L. FORNERIS DO
Provider Business Mailing Address
First Line : 934 S MAIN ST
Second Line :
City : LAYTON
State : UT
Zip : 84041-7135
Country : US
Telephone Number : 801-336-1805
Fax Number :
Provider Business Practice Location Address
First Line : 934 S MAIN ST
Second Line :
City : LAYTON
State : UT
Zip : 84041-7135
Country : US
Telephone Number : 801-336-1805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2022
Last Update Date : 06/11/2026

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Directions to “ KATHRYN L. FORNERIS DO” Practice Location

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