Individual
KELLY MARVIN JEPPESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 WEST 100 NORTH, SUITE A, MONTICELLO, UT 84535-1054
(435) 587-5054
(435) 587-3004
Mailing address
PO BOX 308, MONTICELLO, UT 84535-0308
(435) 587-2116
(435) 587-3004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7730032-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568790558
—
UT
Enumeration date
12/02/2009
Last updated
08/06/2015
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