Individual
KYLE ALLAN VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10433 S REDWOOD RD STE B, SOUTH JORDAN, UT 84095-8502
(801) 260-1919
Mailing address
PO BOX 95590, SOUTH JORDAN, UT 84095-0590
(801) 352-9500
(801) 352-7976
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11353630-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11353630-1206
STATE LICENSE
UT
Enumeration date
07/22/2019
Last updated
07/22/2019
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