Individual
KELLI KEMENAH MAURIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC, APRN
Contact information
Practice address
3772 N MOUNTAINOAK DR, EDEN, UT 84310
(801) 710-2825
Mailing address
3772 N MOUNTAINOAK DR, EDEN, UT 84310
(801) 710-2825
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
10115460-4405
UT
363LW0102X
Women's Health Nurse Practitioner
NP-07962
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000356173
ANTHEM B/C B/S
OH
05
—
0827627
—
OH
01
—
10115460-4405
APRN STATE LICENSURE
UT
01
—
10115460-8900
APRN CONTROLLED SUBSTANCE ID
UT
01
—
104279585
NATIONAL CERTIFICATION CORPORATION - WHNP-BC (BOARD CERTIFIED)
—
01
—
1073270666
NPI BALANCE THE BRAIN PROFESSIONAL CORPORATION
UT
01
—
193200000X
MULTI-SPECIALTY GROUP TAXONOMY BALANCE THE BRAIN PROFESSIONAL CORPORATION
UT
01
—
356173
BUCKEYE
OH
01
—
363LW0102X
NURSE PRACTITIONER - WOMENS HEALTH TAXONOMY
UT
01
—
740142
BUCKEYE MEDICAID
OH
01
—
APP0002758
COPIC RRG VIA BAXTER & ASSOCIATES LLC CERTIFICATE OF LIABILITY INSURANCE
UT
01
—
APRN.CNP.07962
WHNP-BC WITH CERTIFICATE TO PRESCRIBE
OH
01
—
I20180403001591
PECOS ENROLLMENT ID
—
01
—
MAU1-0427-9585
NATIONAL CERTIFICATION CORPORATION -USA WOMENS HEALTH NURSE PRACTITIONER WHNP-BC
OH
01
—
NP-07962
OHIO BOARD OF NURSING - CERTIFICATE OF AUTHORITY FOR WHNP-BC LICENSURE - OH
OH
01
—
P01571485
MEDICARE RR
OH
01
—
R04778
SUMMACARE
OH
01
—
RN266333
NATIONAL COUNCIL OF NURSING STATE BOARDS & LICENSURE REGISTERED NURSES
OH
Enumeration date
04/10/2007
Last updated
06/21/2023
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