Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 6495934-4405 | UT |
NPI | 1003462482 |
---|---|
Provider Name | Kristy Bentley |
First Address | Herriman, UT 84096-8216 |
Second Address | Murray, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |