NICOLE KELLY (NPI# 1013312339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013312339 |
| Entity Type | Individual |
| Full Name | NICOLE KELLY |
| Credential | P.A.-C |
| Practice Address |
12340 S 450 E Draper UT 84020-8154 |
| Mailing Address |
8899 S 700 E Suite 250 Sandy UT 84070-1810 |
| Practice Telephone | 8015019797 |
| Mailing Telephone | 8016132711 |
| Mailing Fax Number | 8018787507 |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2016-08-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9190865-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053849166 | Nicole Shavon Kelly | Contractor | 11 Misty Wood Cir Apt H, Timonium, MD 21093-1338 | 2017-06-02 |
| 1447863220 | Nicole Mary Kelly | Behavior Technician | 320 Saturn St N Ste A, Cosmos, MN 56228-9757 | 2020-08-31 |
| 1437790003 | Nicole Lynn Kelly | Physical Therapist | 411 N Middletown Rd, Media, PA 19063-4059 | 2019-10-03 |
| 1407316813 | Nicole Kelly | Student in an Organized Health Care Education/Training Program | 3959 Broadway, New York, NY 10032-1559 | 2019-03-21 |
| 1881153120 | Nicole Aneiros Kelly | Student in an Organized Health Care Education/Training Program | 505 S Main St Ste 525, Orange, CA 92868-4553 | 2019-03-17 |
| 1225515901 | Nicole Kelly | Counselor | 55 Dodge Rd, Getzville, NY 14068-1205 | 2018-07-25 |
| 1841703923 | Nicole Kelly | Occupational Therapist | 65 Middle Rd, Blue Point, NY 11715-1918 | 2017-11-10 |
| 1336523562 | Nicole Kelly | Physical Therapy Assistant | 35 N 28th St, Superior, WI 54880-5557 | 2015-07-17 |
| 1316326796 | Nicole Kelly | Acupuncturist | 420 Walnut Ave, San Diego, CA 92103-4987 | 2015-05-19 |
| 1093108581 | Nicole Kelly | Behavioral Analyst | 3214 W Mcgraw St Ste 212, Seattle, WA 98199-3239 | 2015-03-09 |
| Street Address |
12340 S 450 E |
| City | DRAPER |
| State | UT |
| Zip Code | 84020-8154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992779185 | Amy B. Killen | Emergency Medicine | 12340 S 450 E, Draper, UT 84020-8154 | 2006-02-14 |
| 1528621752 | Ashlee Williams | Nurse Practitioner | 12340 S 450 E, Draper, UT 84020-8154 | 2019-04-14 |
| 1902286297 | Biorestoration Medical | Family Medicine | 12340 S 450 E, Draper, UT 84020-8154 | 2015-06-02 |
| 1215254529 | Emily S Smith | Physician Assistant | 12340 S 450 E, Draper, UT 84020-8154 | 2010-04-26 |
| 1235355819 | Laurie Childs | Physician Assistant | 12340 S 450 E, Draper, UT 84020-8154 | 2007-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322776 | Chase Larsen Dmd Pllc | Dentist | 723 E 12200 S, Draper, UT 84020 | 2020-10-06 |
| 1780222380 | Derek Cragun | Counselor | 11706 700 E, Draper, UT 84020 | 2019-12-13 |
| 1720629371 | Own My Health Medical | Clinic/Center | 12371 900 E, Suite 102, Draper, UT 84020 | 2019-10-04 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1124670872 | Necia Dalley | Registered Nurse | 11800 S State St, Draper, UT 84020 | 2019-07-12 |
| 1285100784 | Tracey M Williams | Psychologist | 13200 S 1601 E, Draper, UT 84020 | 2018-10-23 |
| 1275008328 | Amoni Paeahelotu Finau | Community Health Worker | 13703 Wheatfield Way, Draper, UT 84020 | 2018-10-04 |
| 1891275525 | Cynthia Mae Bolton | Psychologist | 1192 E Draper Parkway # 447, Draper, UT 84020 | 2018-08-21 |
| 1164908026 | Headin' Home Inc. | Community/Behavioral Health | 12300 S. 150 W., Draper, UT 84020 | 2018-07-13 |
| 1366932576 | Forest Hulet | Dentist | 219 E 12300, Ste I-5, Draper, UT 84020 | 2018-05-14 |
| Find all providers in zip 84020 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194379040 | Tyson Wilcox | Physician Assistant | 11593 S Douglas Vista Dr, Draper, UT 84020-1480 | 2019-07-30 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1336610450 | Cory Michael Rice | Physician Assistant | 12176 S 1000 E Ste 4, Draper, UT 84020-3221 | 2018-12-16 |
| 1366917270 | Trevor Apple | Physician Assistant | 11432 S Loganberry Ct, Draper, UT 84020-9477 | 2018-10-06 |
| 1861852527 | Heidi Johnson | Physician Assistant | 11724 S State St, Draper, UT 84020-7163 | 2016-02-24 |
| 1922481696 | John Hooley | Physician Assistant | 224 E Spencer Peak Way Unit F4, Draper, UT 84020-6956 | 2015-06-30 |
| 1720414204 | Sarah Cookler | Physician Assistant | 1126 E Draper Pkwy, Draper, UT 84020-9095 | 2013-09-17 |
| 1568700375 | Kent Ma | Physician Assistant | 233 W Beverlee Ann Dr, Draper, UT 84020-6875 | 2013-01-29 |
| 1295970515 | Stephanie Boulter | Physician Assistant | 1624 E Cypress Point Way, Draper, UT 84020-8808 | 2008-12-16 |
| 1225288376 | Jennifer Holt Johnson | Physician Assistant | 74 E 11800 S Ste 360, Draper, UT 84020-5006 | 2008-09-25 |
| Find all providers in DRAPER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.