Provider Demographics
NPI:1013138254
Name:ADAMS, KELLY KRISTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:KRISTEN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KRISTEN
Other - Last Name:PLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4686 W CROSSWATER ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDON
Mailing Address - State:UT
Mailing Address - Zip Code:84009
Mailing Address - Country:US
Mailing Address - Phone:470-272-4754
Mailing Address - Fax:855-952-1975
Practice Address - Street 1:4686 W CROSSWATER ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDON
Practice Address - State:UT
Practice Address - Zip Code:84009
Practice Address - Country:US
Practice Address - Phone:470-272-4754
Practice Address - Fax:855-952-1975
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0680912080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126035AMedicaid
GA003126035AMedicaid