Healthcare Provider Details

I. General information

NPI: 1336584861
Provider Name (Legal Business Name): KRISTIN MAY BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 E PONY EXPRESS PKWY STE 1
EAGLE MOUNTAIN UT
84005-5531
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-8037
  • Fax: 801-753-7476
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number85122171206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: