Kathy Jane Pedersen, PA-C, MPAS

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

102701-1206 Issued in UT

Practice address

4745 S 3200 W
Salt Lake City, UT 84118-2822

Phone

(801) 964-6214

NPI assigned

Dec 22, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184803200000",
    "number": "1265419022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 S 3200 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182822",
            "telephone_number": "801-964-6214",
            "fax_number": "801-412-6950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 S 3200 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841182822",
            "telephone_number": "801-964-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "KATHY",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "102701-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Pedersen
• Donald M Pedersen, PA
• Hailey Pedersen
• Jeffrey Pedersen, MD
• Jenny Ann Pedersen, M.S. CCC-A
• Lily Pedersen
• Melissa Lee Pedersen, RN
• Peder J Pedersen, M.D.
• Amber Pederson
• Elise Pederson

• Family Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.