Basic Information
| Provider Information | |||||||||
| NPI: | 1134116783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMANN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753900 | ||||||||
| FaxNumber: | 8014753901 | ||||||||
| Practice Location | |||||||||
| Address1: | 3485 W 5200 S | ||||||||
| Address2: | |||||||||
| City: | ROY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840679438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753900 | ||||||||
| FaxNumber: | 8014753901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 49040751204 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.