Provider Demographics
NPI:1346233996
Name:QUINTON, CONNIE KIM (APRN MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:KIM
Last Name:QUINTON
Suffix:
Gender:F
Credentials:APRN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:590 E 100 N STE 6
Mailing Address - Street 2:PO BOX 1734
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2600
Mailing Address - Country:US
Mailing Address - Phone:435-613-9466
Mailing Address - Fax:435-613-9469
Practice Address - Street 1:590 E 100 N STE 6
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2600
Practice Address - Country:US
Practice Address - Phone:435-613-9466
Practice Address - Fax:435-613-9469
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0190288-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT01902884401001OtherBCBS
UT7076446OtherAETNA
UT87-0530876OtherTAX ID
UT870530876OtherTRICARE
UT0251516OtherPEHP
UT46D1010536OtherCLIA
UT603509700OtherWORKERS COMP
UTQM0000064041OtherALTIUS
UTQM0000064041OtherALTIUS
UT0251516OtherPEHP