Healthcare Provider Details

I. General information

NPI: 1932982998
Provider Name (Legal Business Name): MCKINSEY OWEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 S REDWOOD RD STE 2
SOUTH JORDAN UT
84095-8502
US

IV. Provider business mailing address

10433 S REDWOOD RD STE 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1066677-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11066677-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: