Healthcare Provider Details

I. General information

NPI: 1316851785
Provider Name (Legal Business Name): MEADOWBROOK FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 W 2000 N
MENDON UT
84325-9798
US

IV. Provider business mailing address

701 S MAIN ST STE 114
LOGAN UT
84321-5765
US

V. Phone/Fax

Practice location:
  • Phone: 435-317-5348
  • Fax: 435-252-0791
Mailing address:
  • Phone: 435-317-5348
  • Fax: 435-252-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BROOKE TUTTLE
Title or Position: OWNER
Credential: FNP-C
Phone: 801-671-5738