Provider Demographics
NPI:1437406329
Name:VAN OS, EMILY KRISTEN (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:KRISTEN
Last Name:VAN OS
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KRISTEN
Other - Last Name:PANHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2666 S 2000 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1721
Mailing Address - Country:US
Mailing Address - Phone:801-691-7064
Mailing Address - Fax:801-855-7998
Practice Address - Street 1:2666 S 2000 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1721
Practice Address - Country:US
Practice Address - Phone:801-691-7064
Practice Address - Fax:801-855-7998
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6621217-4405363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily