MEDICARE: KIM STEVENSON APRN-NP

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	363L00000X	Nurse Practitioner	274276-8900	UT
2	363L00000X	Nurse Practitioner	274276-4405	UT

General Provider Information

NPI Number	:	1851542872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM STEVENSON APRN-NP

Provider Business Mailing Address
First Line	:	5620 S WATERBURY WAY # A200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1180
Country	:	US
Telephone Number	:	801-455-8822
Fax Number	:	561-589-6511

Provider Business Practice Location Address
First Line	:	5620 S WATERBURY WAY # A200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1180
Country	:	US
Telephone Number	:	801-455-8822
Fax Number	:	561-589-6511

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	03/24/2023

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Directions to “ KIM STEVENSON APRN-NP” Practice Location

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