MEDICARE: MS. KAYLEEN TERRY A.P.R.N.

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	363LG0600X	Gerontology Nurse Practitioner	150335-4405	UT
2	363LA2200X	Adult Health Nurse Practitioner	150335-4405	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	UT03672	OTHER	UT	MEDICARE SUBMITTER ID NUM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000057906	OTHER	UT	GROUP PIN

General Provider Information

NPI Number	:	1992828958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYLEEN TERRY A.P.R.N.

Provider Business Mailing Address
First Line	:	2223 E VALDE NEIGE CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1073
Country	:	US
Telephone Number	:	801-707-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	8160 S HIGHLAND DR STE 110
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-7403
Country	:	US
Telephone Number	:	801-707-7004
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	02/09/2026

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