Individual
KATIE NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3690 S MAIN ST, SOUTH SALT LAKE, UT 84115-4423
(801) 587-2525
Mailing address
3690 S MAIN ST, SOUTH SALT LAKE, UT 84115-4423
(385) 261-2737
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10970425-1206
UT
363AM0700X
Medical Physician Assistant
10970425-1206
UT
Other
Enumeration date
10/08/2018
Last updated
03/16/2026
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