Provider Demographics
NPI:1043851116
Name:WOODEN, KENZLEE
Entity type:Individual
Prefix:
First Name:KENZLEE
Middle Name:
Last Name:WOODEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENZLEE
Other - Middle Name:
Other - Last Name:JEPPSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5671 S 650 E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-1201
Mailing Address - Country:US
Mailing Address - Phone:801-678-2518
Mailing Address - Fax:
Practice Address - Street 1:845 S MAIN ST STE A7
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6482
Practice Address - Country:US
Practice Address - Phone:801-298-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9158154-8900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health