Individual
MR. KIRK RUSSELL WALDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
770 S 200 E STE 102, BRIGHAM CITY, UT 84302-3387
(801) 513-9652
Mailing address
770 S 200 E STE 102, BRIGHAM CITY, UT 84302-3387
(801) 513-9652
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7301549-8900
UT
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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