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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568412724 NPPES
Other 86519 PEHP #
Other 26837 PEHP #
MEDICAID 100507903 PEHP #

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