Provider Demographics
NPI:1073003059
Name:VOGAN, KATIE ROSE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE ROSE
Middle Name:
Last Name:VOGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATIE ROSE
Other - Middle Name:
Other - Last Name:VOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:6265 E ORION ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-9750
Mailing Address - Country:US
Mailing Address - Phone:254-423-1699
Mailing Address - Fax:
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:602-387-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN191834163WE0003X
AZAP11423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency