Individual
KATELYN MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
50 N MEDICAL DR CLINIC #4, SALT LAKE CITY, UT 84132-0002
(801) 581-2719
Mailing address
7085 N 2200 W APT 1F, PARK CITY, UT 84098-8234
(540) 455-0854
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
13565320-1206
UT
363A00000X
Physician Assistant
Primary
13565320-1206
UT
Other
Enumeration date
07/07/2022
Last updated
03/04/2024
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