Doctor Name: | KORI DAWN KEYLON |
NPI Number: | 1134541972 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA, RT |
License Number: | 6739286-1206 |
Business Practice Address: | East Highway 262 Montezuma Creek, UT - 845340130 |
Business Phone Number: | 4356513700 |
Business Fax Number: | 4356513376 |
Mailing Address: | Po Box 130, MONTEZUMA CREEK |
State: | UT |
Postal Code: | 845340130 |
Phone Number: | 4356513700 |
Fax Number: | 4356513376 |
NPI Enumeration Date: | 01/14/2014 |
NPI Last Update Date: | 01/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 6739286-1206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |