Provider Demographics
NPI:1427497049
Name:CREEDON, KERIANNA LYNNE
Entity type:Individual
Prefix:
First Name:KERIANNA
Middle Name:LYNNE
Last Name:CREEDON
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 1:151 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4427
Mailing Address - Country:US
Mailing Address - Phone:801-851-7127
Mailing Address - Fax:801-851-7198
Practice Address - Street 1:1479 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5104
Practice Address - Country:US
Practice Address - Phone:801-851-7696
Practice Address - Fax:801-851-7699
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator