Provider Demographics
NPI:1780395418
Name:BECKSTROM, KYLEE A (FNP-BC)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:A
Last Name:BECKSTROM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:A
Other - Last Name:MCKELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5265 W BLUEBONNET CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5169 S COTTONWOOD ST STE 520
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6756
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108082544405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily