MEDICARE: KATHRYN KLOSSNER PA-C

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1053094524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN KLOSSNER PA-C

Provider Business Mailing Address
First Line	:	987 S GENEVA RD
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84058-6085
Country	:	US
Telephone Number	:	801-809-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 W REUNION AVE STE 5A
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-4620
Country	:	US
Telephone Number	:	801-809-4482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	07/26/2024

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