Provider Demographics
NPI:1891481404
Name:TAALA, KENNARD L
Entity Type:Individual
Prefix:
First Name:KENNARD
Middle Name:L
Last Name:TAALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-0095
Mailing Address - Country:US
Mailing Address - Phone:385-349-6007
Mailing Address - Fax:
Practice Address - Street 1:537 W 600 S STE 700
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2254
Practice Address - Country:US
Practice Address - Phone:385-347-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)