Provider Demographics
NPI:1558702746
Name:BACKUS, KATHLEEN MARIE (DVM)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:BACKUS
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:BACKUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DVM
Mailing Address - Street 1:450 E BURTON LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2898
Mailing Address - Country:US
Mailing Address - Phone:928-691-0390
Mailing Address - Fax:
Practice Address - Street 1:450 E BURTON LN
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2898
Practice Address - Country:US
Practice Address - Phone:928-691-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369497174M00000X
AZ3410174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT369497OtherLIC
UT369497OtherLIC