Basic Information
| Provider Information | |||||||||
| NPI: | 1699121913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | MARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7309 S 180 W | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840471020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015692153 | ||||||||
| FaxNumber: | 8015679006 | ||||||||
| Practice Location | |||||||||
| Address1: | 7309 S 180 W | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015692153 | ||||||||
| FaxNumber: | 8015679006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2016 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 7546338-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.