Healthcare Provider Details

I. General information

NPI: 1942155544
Provider Name (Legal Business Name): KIERA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S 400 E
OGDEN UT
84405-7194
US

IV. Provider business mailing address

2124 W 3360 S
SYRACUSE UT
84075-9315
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-1777
  • Fax:
Mailing address:
  • Phone: 801-479-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number12625626-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: