Healthcare Provider Details

I. General information

NPI: 1699686436
Provider Name (Legal Business Name): MELIAI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 S WESLEY RD
MURRAY UT
84117-6623
US

IV. Provider business mailing address

5075 S WESLEY RD
MURRAY UT
84117-6623
US

V. Phone/Fax

Practice location:
  • Phone: 940-808-9938
  • Fax:
Mailing address:
  • Phone: 940-808-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY LYNN GIBERSON
Title or Position: OWNER
Credential: PMHNP
Phone: 940-808-9938