Individual
KYLIE CORNWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 581-2121
Mailing address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11146110-1205
UT
Other
Enumeration date
12/15/2017
Last updated
02/04/2019
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