SUSAN KELLY NIEBAUM PMHNP-BC NPI 1861165839

NPI Information

NPI: 1861165839
Provider Name: SUSAN KELLY NIEBAUM, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
408 E KELSEY VIEW LN
SOUTH SALT LAKE, UT
ZIP 84115
Phone: (406) 212-2177
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Susan Kelly Niebaum, PMHNP-BC is a psychiatric/mental health nurse practitioner in South Salt Lake, UT. Susan Kelly Niebaum, PMHNP-BC NPI is 1861165839. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

408 E KELSEY VIEW LN
SOUTH SALT LAKE, UT
ZIP 84115-979
Phone: (406) 212-2177

The enumeration date for this NPI number is 7/27/2021 and was last updated on 2/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	12585557-4405	UTAH	Yes
2	163WP0807X	Registered Nurse	Psychiatric/Mental Health, Child & Adolescent	16869	MONTANA	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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