Individual
KELSEY DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC
Contact information
Practice address
324 E 10TH AVE STE 200, SALT LAKE CITY, UT 84103-2869
(801) 408-7660
Mailing address
1477 S 500 E, SALT LAKE CITY, UT 84105-2046
(810) 869-6378
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
12764506-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
12764506-4405
UT
Other
Enumeration date
03/17/2023
Last updated
04/18/2023
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