Healthcare Provider Details

I. General information

NPI: 1043869639
Provider Name (Legal Business Name): MCKENZIE BRIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 N 3000 W
OGDEN UT
84404-9528
US

IV. Provider business mailing address

1066 N 3000 W
OGDEN UT
84404-9528
US

V. Phone/Fax

Practice location:
  • Phone: 385-501-6052
  • Fax: 801-820-2849
Mailing address:
  • Phone: 385-501-6052
  • Fax: 801-820-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11383505-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: