Keith Thomas Petagna

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

F24-112623 Issued in UT

Practice address

443 S 600 E
Salt Lake City, UT 84102-2708

Phone

(801) 536-6523

NPI assigned

Jun 7, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1992499362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR STE 120",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243550",
            "telephone_number": "888-949-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 S 600 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022708",
            "telephone_number": "801-536-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETAGNA",
        "first_name": "KEITH",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-07",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "UT",
            "license": "F24-112623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Persson, DO, MBA
• Jessica Marie Persson
• Rebecca Rae Pesaresi
• Marcie Lee Pesceone
• Megan Shupe Pessoa, M.S., SLP-CCC
• Sarah Suzanne Petelinsek
• Peter E. Paulos, DDS, Ms
• Brock Peterlin, RN
• Angela Yvonne Peters, M.D.
• Caryn Elaine Peters, PA-C

• Case Manager/Care Coordinator in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Case Manager/Care Coordinator in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.