Most Relevant Information
Provider Data
| NPI Number: | 1003307604 |
| Provider Name: | DIANA M KELLY |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/21/2018 |
| Last Updated: | 05/21/2018 |
Provider Practice Location
1753 SIDEWINDER DR
PARK CITY
UT
840607322
Practice Location Phone/Fax
| Phone: | 4356498347 |
| Fax: |
Provider Mailing Location
4460 S HIGHLAND DR
SALT LAKE CITY
UT
841243543
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |