Provider Demographics
NPI:1144887365
Name:STEVENSON, KATHERINE ELIZABETH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:HOLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 S SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4525
Mailing Address - Country:US
Mailing Address - Phone:858-449-4836
Mailing Address - Fax:
Practice Address - Street 1:12176 S 1000 E STE 10
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-3221
Practice Address - Country:US
Practice Address - Phone:801-553-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9038984-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily