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NPI Code Detail

MEDICARE: KEVIN BRYAN JAMES HUNTINGTON PA-C

MEDICARE: KEVIN BRYAN JAMES HUNTINGTON 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
1363A00000XPhysician Assistant8464916-1206UT
2363A00000XPhysician Assistant8464916-8906UT

General Provider Information

NPI Number : 1144777418
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN BRYAN JAMES HUNTINGTON PA-C
Provider Business Mailing Address
First Line : 1784 UINTA WAY UNIT E2
Second Line :
City : PARK CITY
State : UT
Zip : 84098-7685
Country : US
Telephone Number : 435-604-0160
Fax Number :
Provider Business Practice Location Address
First Line : 1784 UINTA WAY UNIT E2
Second Line :
City : PARK CITY
State : UT
Zip : 84098-7685
Country : US
Telephone Number : 435-604-0160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2016
Last Update Date : 12/20/2021

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Directions to “ KEVIN BRYAN JAMES HUNTINGTON PA-C” Practice Location

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