Provider Demographics
NPI:1528562576
Name:REDFIELD, KIRSTIN LARA (NP-C)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:LARA
Last Name:REDFIELD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:L
Other - Last Name:MCCOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5075 S WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6623
Mailing Address - Country:US
Mailing Address - Phone:801-550-8078
Mailing Address - Fax:
Practice Address - Street 1:5075 S WESLEY RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6623
Practice Address - Country:US
Practice Address - Phone:801-550-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT312709-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT312709-4405OtherDIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING