Healthcare Provider Details

I. General information

NPI: 1760863880
Provider Name (Legal Business Name): KATRINA MARIE BAWDEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E 9TH AVE STE. 106
SALT LAKE CITY UT
84103-2877
US

IV. Provider business mailing address

370 E 9TH AVE STE 106
SALT LAKE CITY UT
84103-3182
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5700
  • Fax: 801-408-5704
Mailing address:
  • Phone: 801-408-5700
  • Fax: 801-408-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5306547-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: