Kimber Tracy Van Wagoner, B.A., R.N.

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

03081433102 Issued in UT

Practice address

1020 S Main St
Salt Lake City, UT 84101-3176

Phone

(801) 539-7000

Fax

(801) 539-7050

NPI assigned

Jan 25, 2006

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

• Ms. Kymber Tracy Van Wagoner Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Registered Nurse

State licenses

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1801866512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 E 2700 S",
            "address_2": "D 26",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062642",
            "telephone_number": "801-486-4104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 S MAIN ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841013176",
            "telephone_number": "801-539-7000",
            "fax_number": "801-539-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGONER",
        "first_name": "KIMBER",
        "middle_name": "TRACY",
        "name_prefix": "Ms.",
        "credential": "B.A., R.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "UT",
            "license": "03081433102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYMBER",
            "last_name": "VAN WAGONER",
            "middle_name": "TRACY",
            "prefix": "MS.",
            "credential": "B.A., R.N.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Camden Van Tassell
• Catherine Van Tassell, P.A.
• Kathryn Van Tassell
• Kathryn Leigh Van Tassell, LCSW
• Kayelynn Van Wagenen, APRN
• Craig Leland Vanalfen, DDS
• Camille Vanarsdol, PHARM D
• Jeffrey R Vanblarcom, M.D.
• Colten Vancampen
• Devin Vance, MFP

• Adult Psychiatric/Mental Health Registered Nurse in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.