MRS. TARA LYNN KAVANAUGH PA-C NPI 1306968482

NPI Information

NPI: 1306968482
Provider Name: MRS. TARA LYNN KAVANAUGH, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: SANTIBANEZ HOLTZCLAW PC

PECOS Registration: Yes

Address:
5505 S 900 E STE 240
MURRAY, UT
ZIP 84117
Phone: (801) 783-5011
Get Directions

MRS. Tara Lynn Kavanaugh, PA-C is a medical physician assistant in Murray, UT with 21 years of experience. MRS. Tara Lynn Kavanaugh, PA-C NPI is 1306968482. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5505 S 900 E STE 240
MURRAY, UT
ZIP 84117-210
Phone: (801) 783-5011
Fax: (801) 746-3734

The NPI 1306968482 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/6/2007 and was last updated on 9/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		PA1111	NEVADA	No
2	363A00000X	Physician Assistant		C0003211	MARYLAND	No
3	363AM0700X	Physician Assistant	Medical	10088016-1206	UTAH	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	KL09Q876	MEDICARE PIN	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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