Healthcare Provider Details

I. General information

NPI: 1992922520
Provider Name (Legal Business Name): KATHY MARIE PARRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SLC VA 500 FOOTHILL DR
SLC UT
84148-0001
US

IV. Provider business mailing address

87 W 300 N #201
SLC UT
84103-1959
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-1938
  • Fax:
Mailing address:
  • Phone: 801-793-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number197221-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: