MEDICARE: DR. NICOLE KRISTINE HEWETT MD

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	ME150803	FL
2	208000000X	Pediatrics Physician	13944363-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982131595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE KRISTINE HEWETT MD

Provider Business Mailing Address
First Line	:	9071 S 1300 W STE 205
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6725
Country	:	US
Telephone Number	:	801-453-9625
Fax Number	:	801-944-7347

Provider Business Practice Location Address
First Line	:	7138 S 2000 E STE 106
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3775
Country	:	US
Telephone Number	:	801-942-1800
Fax Number	:	801-944-1865

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

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	03/12/2026

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