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Individual

MRS. TARA LYNN KAVANAUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5505 S 900 E STE 240, MURRAY, UT 84117-7210
(801) 783-5011
(801) 746-3734
Mailing address
PO BOX 3299, CARSON CITY, NV 89702-3299
(775) 222-0042
(775) 222-0056

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0003211
MD
363A00000X
Physician Assistant
PA1111
NV
363AM0700X
Medical Physician Assistant
Primary
10088016-1206
UT

Other

Enumeration date
04/06/2007
Last updated
07/21/2022
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