MEDICARE: MATTISON KAYTLIN COLLETT

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	13578958-1206	UT

General Provider Information

NPI Number	:	1942929161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTISON KAYTLIN COLLETT

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-0337
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:	801-525-8151

Provider Business Practice Location Address
First Line	:	425 S 100 W
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-5356
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:	801-525-8151

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

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	02/17/2025

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Directions to “ MATTISON KAYTLIN COLLETT ” Practice Location

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