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MRS. TARA LYNN KAVANAUGH PA-C NPI 1306968482


NPI Profile

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

Specialization: Medical

Organization: SANTIBANEZ AGUIRRE PC

PECOS Registration: Yes

Address:
5505 S 900 E STE 240
MURRAY, UT
ZIP 84117
Get Directions

Phone: (801) 783-5011

MRS. Tara Lynn Kavanaugh, PA-C is a medical physician assistant in Murray, UT with 18 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantPA1111NEVADANo
2363A00000XPhysician AssistantC0003211MARYLANDNo
3363AM0700XPhysician AssistantMedical10088016-1206UTAHYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1KL09Q876MEDICARE PINMARYLAND

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: 9/12/2021

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.