Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 184860-1205 | UT |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 184860-1205 | UT |
NPI | 1366407488 |
---|---|
Provider Name | Kristen L. Carroll |
First Address | Los Angeles, CA 90084-0001 |
Second Address | Salt Lake City, UT 84103-4399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76621073 | (05) | UT |
G32554 | (02) | UT |