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Contact Information

KIDIST FISSEHA
1633 W INNOVATION WAY FL 4
LEHI, UT84043-4252
 Phone: 855-726-6363
 Fax: 801-784-1482
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for KIDIST FISSEHA · (Female)

NPI # 1356032262
Status Active
Credentials
Entity Individual
Enumeration date 05/19/2023
Last updated 07/25/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • TX License # 1009883
  • UT License # 9115682-4405
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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