Healthcare Provider Details

I. General information

NPI: 1871212928
Provider Name (Legal Business Name): KENDALL MOELLER DNP, FNP-C, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 S 200 W STE 210
FARMINGTON UT
84025-2425
US

IV. Provider business mailing address

286 S 200 W STE 210
FARMINGTON UT
84025-2425
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-8300
  • Fax: 801-478-6250
Mailing address:
  • Phone: 801-852-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95260559
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number219778
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14264108-44-5
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219778
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60856061
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2353354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: