Provider Demographics
NPI:1881444925
Name:KELTY, KATIANA ROCHELLE (DO, MA)
Entity type:Individual
Prefix:DR
First Name:KATIANA
Middle Name:ROCHELLE
Last Name:KELTY
Suffix:
Gender:F
Credentials:DO, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 700A
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3295
Mailing Address - Country:US
Mailing Address - Phone:801-387-5300
Mailing Address - Fax:801-442-0648
Practice Address - Street 1:4403 HARRISON BLVD STE 700A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3295
Practice Address - Country:US
Practice Address - Phone:801-387-5300
Practice Address - Fax:801-442-0648
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program