KELLY D MIKESELL

WEST JORDAN, UT
NPI1023200888
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: UT  5244260-1206)
Enumeration Date2007-08-15
Last Update Date2017-02-09
Business Address
-- KELLY D MIKESELL PA-C
3570 W 9000 S STE 200
WEST JORDAN, UT 84088-8875
Phone number: 801-566-9211
Mailing Address
-- KELLY D MIKESELL PA-C
1055 N 500 W ATTN: CREDENTIALING
PROVO, UT 84604
Phone number: 801-354-8225
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