Provider Demographics
NPI:1164941829
Name:FLITTON, KATELYN CRYSTAL
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:CRYSTAL
Last Name:FLITTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 N WASHINGTON BLVD APT C304
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3992
Mailing Address - Country:US
Mailing Address - Phone:801-577-5221
Mailing Address - Fax:
Practice Address - Street 1:3060 PORTER AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0621
Practice Address - Country:US
Practice Address - Phone:801-577-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT926727385OtherUNITEDHEALTHCARE