Groomer, Kelli Elaine
Groomer, Kelli Elaine is an individual health care provider with primary practice located at 8 Th Ave & C St , Salt Lake City UT 84143-0001. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Groomer, Kelli Elaine can be contacted via phone (801) 408-3729.Contact Information
Primary practice address
8 Th Ave & C St
Salt Lake City UT 84143-0001
Phone: (801) 408-3729
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 6063472-1206 | Utah |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 6063472-1206 | Utah |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 085.004349 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 385.003199 | Illinois |
Profile Details
| NPI number | 1568412724 |
|---|---|
| LBN Legal business name | Groomer, Kelli Elaine |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 10th, 2006 |
| Last updated | Nov 10th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568412724 | NPPES |
| Other | 86519 | PEHP # | |
| Other | 26837 | PEHP # | |
| MEDICAID | 100507903 | PEHP # |
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