Healthcare Provider Details

I. General information

NPI: 1780375253
Provider Name (Legal Business Name): MERICA KRISTIN CHAPPLE FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERICA KRISTIN OLMO

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTH MARIO CAPECCHI DR
NORTH SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 NORTH MARIO CAPECCHI DR
NORTH SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7818
  • Fax: 801-585-9166
Mailing address:
  • Phone: 801-581-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8291206-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8291206-8900
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number8291206-3102
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8291206-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: