Provider Demographics
NPI:1457603466
Name:LANCE, KELLY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:LANCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E 13800 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5010
Mailing Address - Country:US
Mailing Address - Phone:801-987-8384
Mailing Address - Fax:
Practice Address - Street 1:248 E 13800 S
Practice Address - Street 2:SUITE 3
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5010
Practice Address - Country:US
Practice Address - Phone:801-987-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT214109-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily