Provider Demographics
NPI:1619377165
Name:WOOD, KAYLEE MARIE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:WOOD
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 1:624 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-1515
Mailing Address - Country:US
Mailing Address - Phone:385-219-5383
Mailing Address - Fax:
Practice Address - Street 1:717 W 1850 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1416
Practice Address - Country:US
Practice Address - Phone:801-420-0465
Practice Address - Fax:801-375-4241
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program