MEDICARE: MRS. PATRICIA M STARKS APRN, FNP

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	363LF0000X	Family Nurse Practitioner	344443-4405	UT
2	363L00000X	Nurse Practitioner	344443-4405	UT
3	363LP0200X	Pediatric Nurse Practitioner	344443-4405	UT
4	363LP2300X	Primary Care Nurse Practitioner	344443-4405	UT

General Provider Information

NPI Number	:	1982051785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA M STARKS APRN, FNP

Provider Business Mailing Address
First Line	:	2678 S GLENMARE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3606
Country	:	US
Telephone Number	:	801-583-5854
Fax Number	:

Provider Business Practice Location Address
First Line	:	2678 S GLENMARE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3606
Country	:	US
Telephone Number	:	801-583-5854
Fax Number	:

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

Provider Enumeration Date	:	05/21/2016
Last Update Date	:	11/19/2021

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