Healthcare Provider Details

I. General information

NPI: 1073003059
Provider Name (Legal Business Name): KATIE ROSE VOGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ROSE VOGAN NP

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E BASELINE RD STE 107
MESA AZ
85206-4626
US

IV. Provider business mailing address

4850 E BASELINE RD STE 107
MESA AZ
85206-4626
US

V. Phone/Fax

Practice location:
  • Phone: 480-908-9892
  • Fax:
Mailing address:
  • Phone: 480-908-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11423
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN191834
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: