Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Provo Kidney Care LLC

Organization Nephrology Physician · NPI 1972056893

Provo Kidney Care LLC is a Nephrology Physician in Waltham, Massachusetts. Licensed in Utah. Registered with an NPI since 2016.

Licensed in
UT
In the registry since
2016
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

920 Winter St
Waltham, MA 02451-1521
Phone: (480) 639-7186
Fax: (602) 798-8267
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence 001 (UT)

Record details

NPI number1972056893
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Pamela Vp — Vice President · (480) 639-7186
NPI enumeratedJuly 27, 2016
Last updated in NPPESJuly 27, 2016
Mailing address920 Winter St, Waltham, MA 02451-1521

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