Provider Demographics
NPI:1336923135
Name:CUTLER, MADISON KALEI (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KALEI
Last Name:CUTLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 N 200 E STE 160
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-3175
Mailing Address - Country:US
Mailing Address - Phone:435-750-5599
Mailing Address - Fax:
Practice Address - Street 1:1624 N 200 E STE 160
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-3175
Practice Address - Country:US
Practice Address - Phone:435-750-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14063220-8906207Q00000X, 208VP0000X
UT14063220-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine