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Individual

MR. KRAIG LYNN PACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NPC

Contact information

Practice address
3339 CHEROKEE LN, PROVO, UT 84604-4866
(801) 803-0877
Mailing address
3339 CHEROKEE LN, PROVO, UT 84604-4866

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
115014
CO
363L00000X
Nurse Practitioner
261539-4405
UT
363LA2200X
Adult Health Nurse Practitioner
Primary
261539-4405
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
50634879
CO
Enumeration date
08/16/2005
Last updated
09/09/2021
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