MEDICARE: KATHRYN SILVA 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	020532-1	NY
2	363AS0400X	Surgical Physician Assistant	10267982-1206	UT

General Provider Information

NPI Number	:	1528505138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN SILVA PA-C

Provider Business Mailing Address
First Line	:	1143 E 6720 S
Second Line	:	APT #22
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2792
Country	:	US
Telephone Number	:	717-422-7086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1143 E 6720 S
Second Line	:	APT #22
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2792
Country	:	US
Telephone Number	:	717-422-7086
Fax Number	:

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

Provider Enumeration Date	:	01/21/2017
Last Update Date	:	11/10/2021

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