Provider Demographics
NPI:1609577386
Name:FOX, KIRSTI
Entity Type:Individual
Prefix:
First Name:KIRSTI
Middle Name:
Last Name:FOX
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 1:2661 WASHINGTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3606
Mailing Address - Country:US
Mailing Address - Phone:801-621-8670
Mailing Address - Fax:801-621-4512
Practice Address - Street 1:2661 WASHINGTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3606
Practice Address - Country:US
Practice Address - Phone:801-621-8670
Practice Address - Fax:801-621-4512
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program