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NPI Code Detail

MEDICARE: KIMBERLY POHLMAN PA

MEDICARE:   KIMBERLY  POHLMAN  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant12422287-1206UT
2363AM0700XMedical Physician Assistant152511OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q53565OTHERORUPIN

General Provider Information

NPI Number : 1003898149
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY POHLMAN PA
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-786-7500
Fax Number :
Provider Business Practice Location Address
First Line : 2400 N WASHINGTON BLVD
Second Line :
City : NORTH OGDEN
State : UT
Zip : 84414-7233
Country : US
Telephone Number : 801-786-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 04/25/2022

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Directions to “ KIMBERLY POHLMAN PA” Practice Location

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