Provider Demographics
NPI:1215450986
Name:CABALLERO, KLASINA KATHLEEN (DNP)
Entity type:Individual
Prefix:
First Name:KLASINA
Middle Name:KATHLEEN
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 S TICKLEGRASS RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3212
Mailing Address - Country:US
Mailing Address - Phone:801-867-8345
Mailing Address - Fax:
Practice Address - Street 1:6838 S TICKLEGRASS RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3212
Practice Address - Country:US
Practice Address - Phone:801-867-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7336861-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care