Provider Demographics
NPI:1962990069
Name:VALK, TIARA KATHERINE (LPN)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:KATHERINE
Last Name:VALK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 W 710 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4610
Mailing Address - Country:US
Mailing Address - Phone:435-619-2981
Mailing Address - Fax:
Practice Address - Street 1:730 SPRING DRIVE
Practice Address - Street 2:
Practice Address - City:TOQUERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84774
Practice Address - Country:US
Practice Address - Phone:435-635-0300
Practice Address - Fax:435-635-1133
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT221586-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse