Individual
KELLIE DAUGHARTY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
39 WANDERWOOD WAY, SANDY, UT 84092-4866
(801) 561-8398
(801) 302-0645
Mailing address
PO BOX 1009, RIVERTON, UT 84065-1009
(801) 561-8398
(801) 302-0645
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
322464-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750467155
—
UT
Enumeration date
10/27/2006
Last updated
02/14/2022
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