Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 068091 | GA |
NPI | 1013138254 |
---|---|
Provider Name | Dr. Kelly Kristen Adams |
First Address | South Jordon, UT 84009 |
Second Address | South Jordon, UT 84009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003126035A | (05) | GA |