Provider Demographics
NPI:1326081084
Name:MCFARLANE, KIM THYRILL (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:THYRILL
Last Name:MCFARLANE
Suffix:
Gender:M
Credentials:MPAS, PA-C
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Mailing Address - Street 1:585 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 417
Mailing Address - City:GREEN RIVER
Mailing Address - State:UT
Mailing Address - Zip Code:84525-0417
Mailing Address - Country:US
Mailing Address - Phone:435-564-3434
Mailing Address - Fax:435-564-3214
Practice Address - Street 1:585 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:UT
Practice Address - Zip Code:84525-0417
Practice Address - Country:US
Practice Address - Phone:435-564-3434
Practice Address - Fax:435-564-3214
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT295789-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP5253Medicare UPIN