Individual
SPENCER RANDY KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2250 N 1700 W, LAYTON, UT 84041-1140
(801) 779-3001
(801) 774-6100
Mailing address
PO BOX 460, BOUNTIFUL, UT 84011-0460
(801) 779-3001
(801) 774-6100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4759588-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870430116009
—
UT
Enumeration date
08/14/2008
Last updated
08/14/2008
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