Provider Demographics
NPI:1851542872
Name:STEVENSON, KIM (APRN-NP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:5620 S WATERBURY WAY # A200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1180
Mailing Address - Country:US
Mailing Address - Phone:801-455-8822
Mailing Address - Fax:561-589-6511
Practice Address - Street 1:5620 S WATERBURY WAY # A200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1180
Practice Address - Country:US
Practice Address - Phone:801-455-8822
Practice Address - Fax:561-589-6511
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274276-8900363L00000X
UT274276-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner