Provider Demographics
NPI:1376275982
Name:CUMMINGS, KATIE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 N 2575 W
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8611
Mailing Address - Country:US
Mailing Address - Phone:801-941-6770
Mailing Address - Fax:
Practice Address - Street 1:903 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3112
Practice Address - Country:US
Practice Address - Phone:801-941-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9804857-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily