Individual
DONNA L KICIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
1755 W 8760 S, WEST JORDAN, UT 84088-9397
(385) 267-3951
(385) 304-4749
Mailing address
1755 W 8760 S, WEST JORDAN, UT 84088-9397
(385) 267-3951
(385) 304-4749
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10496682-3102
UT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
104966824405
UT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
104966824408
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/26/2025
Last updated
04/08/2026
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