Basic Information
| Provider Information | |||||||||
| NPI: | 1184717878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOTEN | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1169 E 900 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841051526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015815551 | ||||||||
| FaxNumber: | 8015855393 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 FOOTHILL DR RM 301 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841121106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015815551 | ||||||||
| FaxNumber: | 8015855393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 198627-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.