Provider Demographics
NPI:1629155809
Name:LEWIS, KRISTIN LUND (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LUND
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 W 200 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5009
Mailing Address - Country:US
Mailing Address - Phone:801-796-1333
Mailing Address - Fax:801-443-1164
Practice Address - Street 1:62 E THRIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5559
Practice Address - Country:US
Practice Address - Phone:801-766-8427
Practice Address - Fax:801-766-5657
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1920363A00000X
IDPA-1890363A00000X
UT12660017-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant