Individual
KELLI MARIE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
11129491-3102
UT
363L00000X
Nurse Practitioner
Primary
11129491-4405
UT
Other
Enumeration date
04/10/2026
Last updated
07/20/2026
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