Healthcare Provider Details

I. General information

NPI: 1497690663
Provider Name (Legal Business Name): MCKENNA HIGLEY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S MEDICAL DR # 101
BRIGHAM CITY UT
84302-4715
US

IV. Provider business mailing address

1050 S MEDICAL DR # 101
BRIGHAM CITY UT
84302-4715
US

V. Phone/Fax

Practice location:
  • Phone: 435-538-1733
  • Fax:
Mailing address:
  • Phone: 435-538-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11896869-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: