Provider Demographics
NPI:1114321361
Name:ROSKELLEY, MCKEL ANNE
Entity Type:Individual
Prefix:
First Name:MCKEL
Middle Name:ANNE
Last Name:ROSKELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-6150
Mailing Address - Fax:801-399-2572
Practice Address - Street 1:1355 W 3400 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3376
Practice Address - Country:US
Practice Address - Phone:801-387-6150
Practice Address - Fax:801-399-2572
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9565405-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant