Provider Demographics
NPI:1144014432
Name:NELSON, KAYLEE SARAH (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:SARAH
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2919
Mailing Address - Country:US
Mailing Address - Phone:801-413-8282
Mailing Address - Fax:
Practice Address - Street 1:470 E 3900 S STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2332
Practice Address - Country:US
Practice Address - Phone:801-747-2800
Practice Address - Fax:801-747-5222
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13966398-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant