# KIM MARIE MCKINNON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003302548
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 294366-4405 | UT | — |
| 363LF0000X | Family Nurse Practitioner | 294366-8900 | UT | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 294366-8900 | UT | Yes |

## Other

- **Enumeration date:** 07/09/2018
- **Last updated:** 01/13/2021