Provider Demographics
NPI:1730462102
Name:HENRIE, KRISTEN MICHELE (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELE
Last Name:HENRIE
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 W 200 N
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9722
Mailing Address - Country:US
Mailing Address - Phone:801-390-8233
Mailing Address - Fax:
Practice Address - Street 1:1833 W 200 N
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-9722
Practice Address - Country:US
Practice Address - Phone:801-390-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4916405-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily