Individual
KELLY R AVERETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1200 E 3900 S UNIT G175, SALT LAKE CITY, UT 84124-1300
(801) 268-7405
(801) 268-7435
Mailing address
PO BOX 100253, ATLANTA, GA 30384-0253
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4850503-1206
UT
Other
Enumeration date
10/05/2012
Last updated
02/20/2025
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