Most Relevant Information
Provider Data
| NPI Number: | 1003469867 |
| Provider Name: | KYLE ALLAN VANCE |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 11353630-1206 |
Most Important Dates
| Enumeration Date: | 07/22/2019 |
| Last Updated: | 07/22/2019 |
Provider Practice Location
10433 S REDWOOD RD STE B
SOUTH JORDAN
UT
840958502
Practice Location Phone/Fax
| Phone: | 8012601919 |
| Fax: |
Provider Mailing Location
PO BOX 95590
SOUTH JORDAN
UT
840950590
Provider Mailing Phone/Fax
| Phone: | 8013529500 |
| Fax: | 8013527976 |