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NPI Code Detail

MEDICARE: KRISTIN MICHELE RODGERSON FNP

MEDICARE: KRISTIN MICHELE RODGERSON FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5965650-4405UT

General Provider Information

NPI Number : 1437675998
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MICHELE RODGERSON FNP
Provider Business Mailing Address
First Line : 10259 S CLARKS HILL DR
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-5742
Country : US
Telephone Number : 435-313-1561
Fax Number :
Provider Business Practice Location Address
First Line : 1446 W PLEASANT GROVE BLVD
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-3216
Country : US
Telephone Number : 801-785-5100
Fax Number : 801-785-4597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2017
Last Update Date : 08/16/2017

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