Kidist Fisseha, | |
250 E 200 S Fl 16, Slc, UT 84111-2472 | |
(855) 726-6363 | |
(801) 784-1482 |
Full Name | Kidist Fisseha |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 250 E 200 S Fl 16, Slc, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356032262 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163W00000X | Registered Nurse | 1009883 (Texas) | Secondary |
363LF0000X | Nurse Practitioner - Family | 9115682-4405 (Utah) | Primary |
Entity Name | Wellbe Utah Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1568183523 PECOS PAC ID: 6002292034 Enrollment ID: O20220928003465 |
Mailing Address | Practice Location Address |
---|---|
Kidist Fisseha, 250 E 200 S Fl 16, Slc, UT 84111-2472 Ph: (855) 726-6363 | Kidist Fisseha, 250 E 200 S Fl 16, Slc, UT 84111-2472 Ph: (855) 726-6363 |
Katie Stokes, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1140 E 3900 S Ste 340, Slc, UT 84124 Phone: 801-268-7479 Fax: 801-268-7622 | |
Jessica Nielsen, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 81 N Mario Capecchi Dr, Slc, UT 84113 Phone: 801-587-2042 | |
Ms. Annette Smith Harman, PNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 North Medical Dr., Slc, UT 84113 Phone: 801-662-1200 | |
Freida Johnson-allen, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4568 Highland Dr, Suite 290, Slc, UT 84117 Phone: 801-274-6127 Fax: 801-274-6129 | |
Brent Lee Thompson, NURSE PRACTITIONER Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 441 S Redwood Rd, Slc, UT 84104 Phone: 801-973-2588 Fax: 801-973-6985 | |
Julia Christine Thomas, DNP, APRN, NNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Mario Capecchi Dr, Slc, UT 84113 Phone: 801-662-4100 | |
Mckenzie Blatt, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 50 N Medical Dr, Slc, UT 84132 Phone: 801-581-2747 |