Provider Demographics
NPI:1922574532
Name:BREARTON, KLINTON LANE (DNP)
Entity Type:Individual
Prefix:
First Name:KLINTON
Middle Name:LANE
Last Name:BREARTON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W 800 N STE 302
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2883
Mailing Address - Country:US
Mailing Address - Phone:801-655-0015
Mailing Address - Fax:801-655-0048
Practice Address - Street 1:1443 W 800 N STE 302
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2883
Practice Address - Country:US
Practice Address - Phone:801-655-0015
Practice Address - Fax:801-655-0048
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8459664-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner