Provider Demographics
NPI:1053600171
Name:MCMAHON, KRISTINA TIFFANY (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:TIFFANY
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 200 N
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5304
Mailing Address - Country:US
Mailing Address - Phone:435-619-0519
Mailing Address - Fax:
Practice Address - Street 1:1173 S 250 W
Practice Address - Street 2:SUITE 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6392
Practice Address - Country:US
Practice Address - Phone:435-619-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372279-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily