Provider Demographics
NPI:1710420617
Name:LOFGRAN, KACIE (FNP)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:LOFGRAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:EGBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 E 3900 S
Mailing Address - Street 2:STE 260
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1371
Mailing Address - Country:US
Mailing Address - Phone:801-265-2000
Mailing Address - Fax:801-265-2008
Practice Address - Street 1:1250 E 3900 S STE 260
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1371
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6998915-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily