Provider Demographics
NPI:1043869639
Name:BRIGHT, MCKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 N 400 E STE 102
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3413
Mailing Address - Country:US
Mailing Address - Phone:435-843-1225
Mailing Address - Fax:435-843-1228
Practice Address - Street 1:2376 N 400 E STE 102
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:435-843-1225
Practice Address - Fax:435-843-1228
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11383505-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11383505-1206OtherMEDICAL LICENSE