Healthcare Provider Details

I. General information

NPI: 1194078501
Provider Name (Legal Business Name): KRISTIN K BUYS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 11/27/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 S PARADISE PARKWAY
GARDEN CITY UT
84028
US

IV. Provider business mailing address

288 PARADISE PARKWAY
GARDEN CITY UT
84028
US

V. Phone/Fax

Practice location:
  • Phone: 435-255-1630
  • Fax: 435-946-9124
Mailing address:
  • Phone: 435-255-1630
  • Fax: 435-946-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1511
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8461958-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: