Healthcare Provider Details

I. General information

NPI: 1619698750
Provider Name (Legal Business Name): MCKENZIE TONKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7396 S UNION PARK AVE STE 201
MIDVALE UT
84047-6702
US

IV. Provider business mailing address

7396 S UNION PARK AVE STE 201
MIDVALE UT
84047-6702
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-1400
  • Fax: 801-567-1777
Mailing address:
  • Phone: 801-567-1400
  • Fax: 801-567-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14284681
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: