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NPI Code Detail

MEDICARE: MS. KATHLEEN ANN STILLION-ALLEN A.P.R.N.

MEDICARE: MS. KATHLEEN ANN STILLION-ALLEN A.P.R.N.
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
1363LF0000XFamily Nurse Practitioner2026014405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1XXXXXXXXXX0601OTHERBLUE CROSS/BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3236004OTHERUTALTIUS
47648OTHERUTHEALTHY U

General Provider Information

NPI Number : 1770615296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN ANN STILLION-ALLEN A.P.R.N.
Provider Business Mailing Address
First Line : 1856 E 4650 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-5102
Country : US
Telephone Number : 801-819-4919
Fax Number : 801-274-6129
Provider Business Practice Location Address
First Line : 1856 E 4650 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-5102
Country : US
Telephone Number : 801-819-4919
Fax Number : 801-274-6129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2007
Last Update Date : 12/31/2012

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