Provider Demographics
NPI:1194390971
Name:SWAHN, THOMAS KEVIN (NP-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEVIN
Last Name:SWAHN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 S 2775 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7095
Mailing Address - Country:US
Mailing Address - Phone:801-390-4972
Mailing Address - Fax:
Practice Address - Street 1:1013 W 2700 S
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8973
Practice Address - Country:US
Practice Address - Phone:801-613-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8002260-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily