Provider Demographics
NPI:1952105975
Name:SHAW, KATHRYN KIMBERLY (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KIMBERLY
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N MAIN ST APT 314
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6170
Mailing Address - Country:US
Mailing Address - Phone:435-760-0697
Mailing Address - Fax:
Practice Address - Street 1:3315 W MAYFLOWER WAY STE 4
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2927
Practice Address - Country:US
Practice Address - Phone:801-224-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9848969-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily