Kenyon James Bott, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Hyrum, UT
NPI 1790071033 · NPPES record last updated Jun 24, 2011
Key facts
- NPI
- 1790071033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 376170-4408 (UT)
- Practice address
- 133 N 500 W
Hyrum, UT 84319-1080 - Phone
- (435) 245-3443
- NPI assigned
- Jun 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 376170-4408 | UT | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 376170-4408 | UT | Yes |
Addresses
Primary practice location
133 N 500 W
Hyrum, UT 84319-1080
Mailing address
133 N 500 W
Hyrum, UT 84319-1080
Phone (435) 245-3443
Other providers in Hyrum, UT
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- Kevin N Barlow
- Katelyn Emily Blanchard
- Brett Robert Boschetto
- Alondra Cardiel
- Rebekah Marie Clauson
- Comprehensive Family Dental PC
- Conger Drug Inc
- Conger Drug Inc
All providers in Hyrum, UT · Psychiatric/Mental Health Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.