Provider Demographics
NPI:1699121913
Name:BROWN, KRISTEN MARI
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARI
Last Name:BROWN
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 1:7309 S 180 W
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1020
Mailing Address - Country:US
Mailing Address - Phone:801-569-2153
Mailing Address - Fax:801-567-9006
Practice Address - Street 1:7309 S 180 W
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-569-2153
Practice Address - Fax:801-567-9006
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7546338-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health