Provider Demographics
NPI:1144494113
Name:HYLAND, KELLI JO (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:JO
Last Name:HYLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 9100 BOX 3203
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AA
Mailing Address - Zip Code:34002-3203
Mailing Address - Country:US
Mailing Address - Phone:801-865-8932
Mailing Address - Fax:
Practice Address - Street 1:UNIT 9100 BOX 3203
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AA
Practice Address - Zip Code:34002-3203
Practice Address - Country:US
Practice Address - Phone:801-865-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6851342-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry