Provider Demographics
NPI:1457808677
Name:STEPHENS, CARRIE EMILY (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:EMILY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C230
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1297
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:866-415-6807
Practice Address - Street 1:5131 S COTTONWOOD ST # L-2
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-263-3416
Practice Address - Fax:801-263-3416
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9895825-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant