Provider Demographics
NPI:1790034916
Name:KIMBALL, ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10623 S REDWOOD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2481
Mailing Address - Country:US
Mailing Address - Phone:801-302-0899
Mailing Address - Fax:801-302-0892
Practice Address - Street 1:10623 S REDWOOD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2481
Practice Address - Country:US
Practice Address - Phone:801-302-0899
Practice Address - Fax:801-253-1602
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2022-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8413247-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant