MEDICARE: VICTORIA KRAVETS 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
2	363A00000X	Physician Assistant	PA031370	DC
3	363A00000X	Physician Assistant	11909486-1206	UT

General Provider Information

NPI Number	:	1811417264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA KRAVETS PA-C

Provider Business Mailing Address
First Line	:	828 N EASTCAPITOL BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2212
Country	:	US
Telephone Number	:	801-699-8403
Fax Number	:

Provider Business Practice Location Address
First Line	:	5496 S 900 E
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-7204
Country	:	US
Telephone Number	:	801-281-3223
Fax Number	:

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	03/10/2026

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