KELLY D MIKESELL (NPI# 1023200888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023200888 |
| Entity Type | Individual |
| Full Name | KELLY D MIKESELL |
| Credential | PA-C |
| Practice Address |
3570 W 9000 S Ste 200 West Jordan UT 84088-8875 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604 |
| Practice Telephone | 8015669211 |
| Practice Fax Number | 8015665667 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2017-02-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5244260-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3570 W 9000 S STE 200 |
| City | WEST JORDAN |
| State | UT |
| Zip Code | 84088-8875 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487683462 | West Jordan Medical Center PC | Obstetrics & Gynecology | 3570 W 9000 S Ste 200, West Jordan, UT 84088-8875 | 2006-07-01 |
| 1942580220 | Natalie Christina Carter | Nurse Practitioner | 3570 W 9000 S Ste 200, West Jordan, UT 84088-8875 | 2011-08-18 |
| 1467485342 | Joan N Bentley | Nurse Practitioner | 3570 W 9000 S Ste 200, West Jordan, UT 84088-8875 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881178655 | Sierra Burt | Physician Assistant | 3584 West 90000 South Suite 304, West Jordan, UT 84088 | 2018-09-18 |
| 1659861847 | Miller Anesthesia Consultants PC | Anesthesiology | Jvmc Dept. of Anesthesiology, 3580 W. 9000 S., West Jordan, UT 84088 | 2018-05-14 |
| 1821501495 | Cleo Stephanides Cheney | Dentist | 8846 South Redwood Rd., Suite N201, West Jordan, UT 84088 | 2017-11-06 |
| 1124546742 | Crystal Lynn Santos | Counselor | 4431 8200 S, West Jordan, UT 84088 | 2017-09-04 |
| 1154705960 | Heston Farnsworth | Dentist | 9217 South Redwood Road, Suite B, West Jordan, UT 84088 | 2015-07-13 |
| 1750778767 | Andrew Cantwell | Dentist | 3855 7800 South #150, West Jordan, UT 84088 | 2015-04-17 |
| 1962764282 | Steven Howard Reano | Specialist | 8789 S Redwood Road, Ste 100, West Jordan, UT 84088 | 2012-06-12 |
| 1528328846 | Orthodontic Payment Services, LLC | Dentist | 1231 W 9000 S #d, West Jordan, UT 84088 | 2012-05-21 |
| 1588932321 | Jessica Millard | Counselor | 9278 S 1700 W, West Jordan, UT 84088 | 2011-12-08 |
| 1346553062 | Barbara Rouse | Counselor | 9278 Redwood Rd, West Jordan, UT 84088 | 2010-07-22 |
| Find all providers in zip 84088 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598002602 | Bryce Paul Jensen | Physician Assistant | 3570 W 9000 S, Suite 200, West Jordan, UT 84088-8869 | 2013-01-09 |
| 1467775403 | Jeffrey Michael Pollock | Physician Assistant | 8822 S Redwood Rd, Suite C111, West Jordan, UT 84088-9336 | 2010-03-04 |
| 1982883856 | Kyle W Harmer | Physician Assistant | 3181 W 9000 S, West Jordan, UT 84088-5610 | 2007-10-29 |
| 1508900127 | Anna I Mair | Physician Assistant | 3570 W 9000 S, #210, West Jordan, UT 84088-8876 | 2007-02-16 |
| 1932240207 | David Douglas | Physician Assistant | 1745 W 7800 S, West Jordan, UT 84088-4017 | 2007-02-09 |
| 1639218969 | Ashley J Reeder | Physician Assistant | 7478 Campus View Dr, Suite 100, West Jordan, UT 84084-1966 | 2007-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748080 | Shannon Dhungel | Physician Assistant | 82 S 1100 E Ste 402, Salt Lake City, UT 84102-1892 | 2020-04-10 |
| 1437702875 | Jennica Marie Van Blerkom | Physician Assistant | 4755 S Wallace Ln, Holladay, UT 84117-6458 | 2019-07-23 |
| 1124599873 | Tcfh Lc | Physician Assistant | 9777 N 5520 W, Highland, UT 84003-9130 | 2018-12-06 |
| 1528533825 | Ryan Mclean Walsh | Physician Assistant | 1454 University Vlg, Salt Lake City, UT 84108-3518 | 2018-10-12 |
| 1033627351 | Linda Richards Lewis | Physician Assistant | 30 N. 1900 E, Som 5r218, Salt Lake City, UT 84132-0002 | 2018-01-22 |
| 1215446919 | Richard L Mittan | Physician Assistant | 65 E 6850 S, Midvale, UT 84047-1215 | 2017-09-25 |
| 1710416649 | Brian Adams | Physician Assistant | 1308 E 900 S # C, St George, UT 84790-8520 | 2017-06-05 |
| 1972036242 | Jace Meng | Physician Assistant | 30 N 1900 E Rm 5r218, Salt Lake City, UT 84132-0002 | 2017-04-04 |
| 1396289799 | Jefferson M Allen | Physician Assistant | 356 W 840 S, Orem, UT 84058-6778 | 2016-12-05 |
| 1609324151 | Colby Bliss | Physician Assistant | 826 N Paiute Way, Richfield, UT 84701-1849 | 2016-09-13 |
| Find all providers with the same taxonomy | ||||
| City | WEST JORDAN |
| Zip Code | 84088 |
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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.