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General NPI Number Information
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NPI Number | 1912612375
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Entity Type | Individual
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Provider Name | KATIE CAMILLE TAYON
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Gender | Female
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 220 MILLPOND STE 100
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City | STANSBURY PARK
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State | UT
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Zip | 84074-9760
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Country | US
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Telephone | 435-843-3072
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Fax | 435-843-3050
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Provider Business Mailing Address
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Address Line | 220 MILLPOND STE 100
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City | STANSBURY PARK
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State | UT
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Zip | 84074-9760
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Country | US
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Telephone | 435-843-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9902215-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 9902215-4405
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License Number State | UT
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