Healthcare Provider Details

I. General information

NPI: 1942651682
Provider Name (Legal Business Name): KIMBERLY MOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E RM 2B200
SALT LAKE CITY UT
84132-2209
US

IV. Provider business mailing address

30 N 1900 E RM 2B200
SALT LAKE CITY UT
84132-2209
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7647
  • Fax:
Mailing address:
  • Phone: 801-581-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11758460-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number11758460-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: