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Individual

NICOLE KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
12340 S 450 E, DRAPER, UT 84020-8154
(801) 501-9797
Mailing address
8899 S 700 E, SUITE 250, SANDY, UT 84070-1810
(801) 613-2711
(801) 878-7507

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9190865-1206
UT

Other

Enumeration date
10/29/2014
Last updated
08/01/2016
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