Provider Demographics
NPI:1285364570
Name:BRIGHTSHUE, KORTNEE SANDRA
Entity type:Individual
Prefix:
First Name:KORTNEE
Middle Name:SANDRA
Last Name:BRIGHTSHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 W 2525 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8999
Mailing Address - Country:US
Mailing Address - Phone:801-390-0647
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 4410
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3323
Practice Address - Country:US
Practice Address - Phone:801-387-6850
Practice Address - Fax:801-387-6855
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10827123-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner