Individual
KATIE ELAINE RIDGE MCKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 N STATE ST STE 105, PROVO, UT 84604-1354
(801) 655-5245
Mailing address
1281 CHERRY LN, PROVO, UT 84604-3622
(909) 915-4077
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13072448-1206
UT
Other
Enumeration date
08/02/2022
Last updated
01/08/2023
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