Healthcare Provider Details

I. General information

NPI: 1427987239
Provider Name (Legal Business Name): MAKENNA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 S 1500 W
VEYO UT
84782-4097
US

IV. Provider business mailing address

980 S 1500 W
VEYO UT
84782-4097
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-4381
  • Fax:
Mailing address:
  • Phone: 435-705-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10836812-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-98841
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: