Provider Demographics
NPI:1689098808
Name:DURADE, KELLY MARYANN
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARYANN
Last Name:DURADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARYANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 S 400 E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-673-3528
Mailing Address - Fax:435-628-6425
Practice Address - Street 1:620 S 400 E
Practice Address - Street 2:SUITE 400
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-673-3528
Practice Address - Fax:435-628-6425
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5740576-310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse