NPIMap

Organization Active NPI

Kelly Wosnik Inc

  • Clinic/Center
  • Orem, UT
National Provider Identifier
1346549060
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
327710-4405 Issued in UT
Legal business name
KELLY WOSNIK INC
Practice address
1125 W Center St
Orem, UT 84057-5207
Phone
(801) 903-5903
Fax
(801) 515-0935
NPI assigned
Mar 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Dr. Kelly Wosnik, NP-CNPI 1356353601
Title
Medical Director
Phone
(801) 903-5903

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 327710-4405 UT Primary

Addresses

Primary practice location

1125 W Center St
Orem, UT 84057-5207

Mailing address

935 S Orem Blvd
Orem, UT 84058-5011
Phone (801) 903-5903

Other practice location 1

935 S Orem Blvd
Orem, UT 84058-5011
Phone (801) 903-5903

Other identifiers 1

IdentifierTypeStateIssuer
1010479MedicaidUT

Other names 1

  • Bristol Health Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1346549060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 S OREM BLVD",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840585011",
            "telephone_number": "801-903-5903",
            "fax_number": "801-515-0935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 W CENTER ST",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840575207",
            "telephone_number": "801-903-5903",
            "fax_number": "801-515-0935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "935 S Orem Blvd",
            "address_purpose": "LOCATION",
            "city": "Orem",
            "state": "UT",
            "postal_code": "840585011",
            "country_code": "US",
            "telephone_number": "801-903-5903",
            "fax_number": "801-515-0935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELLY WOSNIK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-21",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "WOSNIK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "801-903-5903",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "327710-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010479",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bristol Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.