Kimberly Lan Deatley, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

11415641-1205 Issued in UT

Practice address

501 S Chipeta Way
Salt Lake City, UT 84132-1222

Phone

(801) 581-4096

NPI assigned

Apr 17, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kim Lan Deatley Other name

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Texas a & M University System, HSC, College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdeatley652603@direct.med.utah.edu

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.

• Catholic Health Initiatives Colorado

  • Prescribing (Medical) Psychologist
  • West Valley City, UT
  • NPI 1942903562
  Medicare reassignment Care Compare group NPD
• Catholic Health Initiatives Colorado

  • Orthopaedic Surgery Physician
  • Cottonwood Heights, UT
  • NPI 1548962897
  NPD
• Catholic Health Initiatives Colorado

  • Orthopaedic Surgery Physician
  • Longmont, CO
  • NPI 1891675294
  NPD

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1477040236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841321222",
            "telephone_number": "801-581-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841321222",
            "telephone_number": "801-581-4096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3460 S 4155 W",
            "address_purpose": "LOCATION",
            "city": "West Valley City",
            "state": "UT",
            "postal_code": "84120",
            "country_code": "US",
            "telephone_number": "801-964-3550",
            "fax_number": "801-964-3575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEATLEY",
        "first_name": "KIMBERLY",
        "middle_name": "LAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-17",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "11415641-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "DEATLEY",
            "middle_name": "LAN",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nathan C. Dean, M.D.
• Annalise M. Deane, MD
• Madeline Deangelo, MD
• Lance Brown Dearden, OTR/L
• Sydney Joann Dearden
• Hayley Debacker, PHARM.D.
• Claire Debasitis
• Michelle Lynne Precourt Debbink, M.D.
• Steve Debois, PH.D.
• Katie Renee Debry

• Psychiatry Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.