Active NPI
Kristina L Kelly Rose
- Clinical Social Worker
- Layton, UT
National Provider Identifier
1205109352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5059033-3502
- Practice address
- 1086 E Highway 193 Ste 103
Layton, UT 84040-8589 - Phone
- (801) 336-8475
- NPI assigned
- Feb 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5059033-3502 | UT | Primary |
Addresses
Primary practice location
1086 E Highway 193 Ste 103
Layton, UT 84040-8589
Mailing address
306 N 1500 E
Layton, UT 84040-4558
Phone (801) 336-8475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5059033-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437004800000",
"number": "1205109352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 N 1500 E",
"city": "LAYTON",
"state": "UT",
"postal_code": "840404558",
"telephone_number": "801-336-8475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1086 E HIGHWAY 193 STE 103",
"city": "LAYTON",
"state": "UT",
"postal_code": "840408589",
"telephone_number": "801-336-8475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY ROSE",
"first_name": "KRISTINA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-21",
"last_updated": "2015-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "5059033-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.