Healthcare Provider Details

I. General information

NPI: 1831290790
Provider Name (Legal Business Name): KYLE J CHRISTENSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MAIN ST STE B
RICHFIELD UT
84701-2069
US

IV. Provider business mailing address

1000 N MAIN ST
RICHFIELD UT
84701-2061
US

V. Phone/Fax

Practice location:
  • Phone: 435-893-0800
  • Fax:
Mailing address:
  • Phone: 435-893-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2006-0022
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: