Individual
KELLY HENDERSON HARLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
3895 HARRISON BLVD, OGDEN, UT 84403-2312
(801) 387-7678
Mailing address
3029 N WHISPERING MEADOW LN, PLAIN CITY, UT 84404-9266
(801) 645-9935
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
342773-4810
UT
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
342773-4810
UT
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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