MEDICARE: KELSON PHYSICIAN PARTNER'S OF LAYTON, INC.

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1902349657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELSON PHYSICIAN PARTNER'S OF LAYTON, INC.

Provider Business Mailing Address
First Line	:	2086 N 1700 W
Second Line	:	SUITE C
City	:	LAYTON
State	:	UT
Zip	:	84041
Country	:	US
Telephone Number	:	801-927-1558
Fax Number	:	801-927-1591

Provider Business Practice Location Address
First Line	:	5682 S 3500 W STE A
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-9108
Country	:	US
Telephone Number	:	801-927-1558
Fax Number	:	801-927-1591

Authorized Official
Title or Position	:	CEO
Name	:	MR. MATTHEW WEST
Credential	:
Telephone Number	:	801-927-1558

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	06/24/2024

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