Provider Demographics
NPI:1710990924
Name:ECKERT, KATHRYN LYNN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S CHIPETA WAY RM 2W414
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1287
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:
Practice Address - Street 1:295 S CHIPETA WAY RM 2W414
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1287
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV75452080P0205X
UT14196138-1205207SG0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0207XAllopathic & Osteopathic PhysiciansMedical GeneticsMedical Biochemical Genetics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016664Medicaid
NV002016570Medicaid
11040199OtherCAQH