Provider Demographics
NPI:1871274217
Name:STRINGHAM, KEVIN DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:STRINGHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3921
Mailing Address - Country:US
Mailing Address - Phone:801-787-0046
Mailing Address - Fax:
Practice Address - Street 1:987 S GENEVA RD STE 116
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6085
Practice Address - Country:US
Practice Address - Phone:801-863-7982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11635877-1206363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant