Provider Demographics
NPI:1750858080
Name:KAUFMAN, KARLEE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:
Last Name:KAUFMAN
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 1:4403 HARRISON BLVD STE 3680
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3289
Mailing Address - Country:US
Mailing Address - Phone:801-387-4750
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 3680
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3289
Practice Address - Country:US
Practice Address - Phone:801-387-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7187363A00000X
UT12966819-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7187OtherARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS
UT12966819-1206OtherSTATE OF UTAH DOPL
UT12966819-8906OtherSTATE OF UTAH DOPL CONTROLLED SUBSTANCE LICENSE