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General NPI Number Information
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NPI Number | 1972389708
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Entity Type | Individual
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Provider Name | KRISTYNA CLEMINSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 6100 S FASHION BLVD
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City | MURRAY
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State | UT
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Zip | 84107-7358
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Country | US
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Telephone | 801-581-2955
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Fax |
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Provider Business Mailing Address
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Address Line | HELIX: 30 N MARIO CAPECCHI RM 1S100
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City | SALT LAKE CITY
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State | UT
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Zip | 84112
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Country | US
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Telephone | 801-581-2121
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 13580797-1205
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License Number State | UT
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