Provider Demographics
NPI:1922380153
Name:KIMBALL, PAIGE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W BLUE GRASS BLVD STE 200-31
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4188
Mailing Address - Country:US
Mailing Address - Phone:801-855-6368
Mailing Address - Fax:801-702-8627
Practice Address - Street 1:2901 W BLUE GRASS BLVD STE 200-31
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4188
Practice Address - Country:US
Practice Address - Phone:801-855-6368
Practice Address - Fax:801-702-8627
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7215609-4405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily