Healthcare Provider Details

I. General information

NPI: 1912813858
Provider Name (Legal Business Name): BROUQUELYN MIA HATFIELD-KNIGHT RDH BSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 W MAIN ST
GREEN RIVER UT
84525
US

IV. Provider business mailing address

2954 E DESERT SOL CT UNIT 23
MOAB UT
84532-6148
US

V. Phone/Fax

Practice location:
  • Phone: 435-564-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number14280826-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: