Provider Demographics
NPI:1508620188
Name:KENT, BRANDON ROBERT (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ROBERT
Last Name:KENT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 W INNOVATION WAY FL 4
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4252
Mailing Address - Country:US
Mailing Address - Phone:855-726-6363
Mailing Address - Fax:
Practice Address - Street 1:1633 W INNOVATION WAY FL 4
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4252
Practice Address - Country:US
Practice Address - Phone:855-726-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT379804-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily