Provider Demographics
NPI:1770615296
Name:STILLION-ALLEN, KATHLEEN ANN (APRN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:STILLION-ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 E 4650 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5102
Mailing Address - Country:US
Mailing Address - Phone:801-819-4919
Mailing Address - Fax:801-274-6129
Practice Address - Street 1:1856 E 4650 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5102
Practice Address - Country:US
Practice Address - Phone:801-819-4919
Practice Address - Fax:801-274-6129
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2026014405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXXXXXX0601OtherBLUE CROSS/BLUE SHIELD
UTXXXXXXXXX002Medicaid
UT236004OtherALTIUS
UT7648OtherHEALTHY U
XXXXXXXXXX0601OtherBLUE CROSS/BLUE SHIELD
UT005797701Medicare ID - Type Unspecified