Individual
KELLI ELAINE GROOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
8 TH AVE & C ST, SALT LAKE CITY, UT 84143-0001
(801) 408-3729
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 408-3729
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6063472-1206
UT
363AM0700X
Medical Physician Assistant
085.004349
IL
363AM0700X
Medical Physician Assistant
385.003199
IL
363AM0700X
Medical Physician Assistant
6063472-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507903
—
NV
01
—
26837
ALTIUS #
—
01
—
86519
PEHP #
—
Enumeration date
05/10/2006
Last updated
11/10/2016
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