Healthcare Provider Details

I. General information

NPI: 1285599159
Provider Name (Legal Business Name): MAKENZI ELISE KYGAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S LEFT HAND FORK HOBBLE CYN
SPRINGVILLE UT
84663-6165
US

IV. Provider business mailing address

150 S 500 E
SALEM UT
84653-9544
US

V. Phone/Fax

Practice location:
  • Phone: 385-500-3529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number13982773-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: