Provider Demographics
NPI:1174190052
Name:MCMINIMEE, KATE MARIE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:MCMINIMEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 E NORTH HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3337
Mailing Address - Country:US
Mailing Address - Phone:801-520-3093
Mailing Address - Fax:
Practice Address - Street 1:585 E NORTH HILLS DR
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84103-3337
Practice Address - Country:US
Practice Address - Phone:801-520-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9701210-3102163WX0002X
UT9701210-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk