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NPI Code Detail

MEDICARE: MICHELE MUCHMORE PMHNP

MEDICARE: MICHELE MUCHMORE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2363LP0808XPsychiatric/Mental Health Nurse Practitioner288517-4405UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2260022408OTHERUTRAILROAD MEDICARE
3000055266OTHERUTMEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447904313
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE MUCHMORE PMHNP
Provider Business Mailing Address
First Line : 3903 MEDICAL DR STE 300
Second Line :
City : OGDEN
State : UT
Zip : 84403-2317
Country : US
Telephone Number : 801-386-5600
Fax Number :
Provider Business Practice Location Address
First Line : 3903 MEDICAL DR STE 300
Second Line :
City : OGDEN
State : UT
Zip : 84403-2317
Country : US
Telephone Number : 801-387-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2022
Last Update Date : 10/30/2023

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