Individual
KATRIEN JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1915 W 5950 S, ROY, UT 84067-1454
(801) 387-8100
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13028685-1206
UT
Other
Enumeration date
04/28/2021
Last updated
11/21/2025
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