Basic Information
| Provider Information | |||||||||
| NPI: | 1578707824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHBURN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | CROUGHWELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CROUGHWELL | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3570 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841103570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017272056 | ||||||||
| FaxNumber: | 7707016675 | ||||||||
| Practice Location | |||||||||
| Address1: | 5121 S COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015077000 | ||||||||
| FaxNumber: | 7707016675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2009 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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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 | 207L00000X | 2015-01681 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 37151 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 10299311-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 371519 | 05 | SC | MEDICAID |