Healthcare Provider Details

I. General information

NPI: 1588514467
Provider Name (Legal Business Name): KATHRYN I VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN I DAVIS

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SLC UT
84132-0001
US

IV. Provider business mailing address

13933 S DORNOCH DR
HERRIMAN UT
84096-6775
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-414-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6649276-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number6649276-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: