Individual
KEVIN LYMAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3570 W 9000 S, WEST JORDAN, UT 84088-8869
(801) 903-5620
(385) 351-6718
Mailing address
5242 S COLLEGE DR STE 200, MURRAY, UT 84123-2918
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12857669-1206
UT
363AM0700X
Medical Physician Assistant
12857669-1206
UT
Other
Enumeration date
07/14/2022
Last updated
11/26/2024
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