Provider Demographics
NPI:1144650664
Name:VISKER, JAMES KEVIN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:VISKER
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1881 W TRAVERSE PKWY
Mailing Address - Street 2:STE E510
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5986
Mailing Address - Country:US
Mailing Address - Phone:385-434-1141
Mailing Address - Fax:801-434-1141
Practice Address - Street 1:1881 W TRAVERSE PKWY
Practice Address - Street 2:STE E510
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5986
Practice Address - Country:US
Practice Address - Phone:385-434-1141
Practice Address - Fax:801-335-5125
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT264688-3102163W00000X
UT264688-4405363LA2200X, 363LG0600X, 363LP2300X
UT264688-44059363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology