Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 47796931205 | UT |
N | 208000000X | Pediatrician | 47796938905 | UT |
NPI | 1003051756 |
---|---|
Provider Name | Kristina Mckinley |
First Address | Salt Lake City, UT 84105-3704 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2008 |
Last Update Date | 20/12/2021 |