Provider Demographics
NPI:1245440478
Name:COTTLE, KEVIN (APRN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:COTTLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 W 9800 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3211
Mailing Address - Country:US
Mailing Address - Phone:801-567-9780
Mailing Address - Fax:801-567-9826
Practice Address - Street 1:3556 W 9800 S
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3211
Practice Address - Country:US
Practice Address - Phone:801-567-9780
Practice Address - Fax:801-567-9826
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3289814405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily