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Individual
KELLIE PAGE
Active
Individual
KELLIE PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10411276-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10411276-4405
DOPL
UT
Enumeration date
07/04/2021
Last updated
10/10/2022
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