Kayelynn Van Wagenen, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2125534405 Issued in UT

Practice address

400 C St
Salt Lake City, UT 84143-1005

Phone

(801) 408-5319

NPI assigned

Aug 2, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Utah Heart Clinic. LC

  • Cardiovascular Disease Physician
  • Murray, UT
  • NPI 1811093453
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1215944913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-408-5319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 C ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841431005",
            "telephone_number": "801-408-5319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGENEN",
        "first_name": "KAYELYNN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "2125534405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Sarah Van Staden
• Camden Van Tassell
• Catherine Van Tassell, P.A.
• Kathryn Van Tassell
• Kathryn Leigh Van Tassell, LCSW
• Kimber Tracy Van Wagoner, B.A., R.N.
• Craig Leland Vanalfen, DDS
• Camille Vanarsdol, PHARM D
• Jeffrey R Vanblarcom, M.D.
• Colten Vancampen

• Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.