Provider Demographics
NPI:1891288924
Name:PERSCHON, KIMBERLY BACHMAN (NP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BACHMAN
Last Name:PERSCHON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4488 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5891
Mailing Address - Country:US
Mailing Address - Phone:801-698-8836
Mailing Address - Fax:
Practice Address - Street 1:3838 W PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-6336
Practice Address - Country:US
Practice Address - Phone:385-401-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5376702-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1891288924Medicaid