Provider Demographics
NPI:1437675998
Name:RODGERSON, KRISTIN MICHELE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:RODGERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10259 S CLARKS HILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5742
Mailing Address - Country:US
Mailing Address - Phone:435-313-1561
Mailing Address - Fax:
Practice Address - Street 1:1446 W PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3216
Practice Address - Country:US
Practice Address - Phone:801-785-5100
Practice Address - Fax:801-785-4597
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5965650-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily