Individual
CAROL A LEATHERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
750 ROUND VALLEY DR, SUITE 200, PARK CITY, UT 84060-7548
(435) 658-7246
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 658-7246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9454093-1206
UT
363AS0400X
Surgical Physician Assistant
PA920
KY
Other
Enumeration date
05/04/2006
Last updated
03/29/2017
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