Healthcare Provider Details

I. General information

NPI: 1811554751
Provider Name (Legal Business Name): LANDON ROBERT MOYERS APRN, DNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E 11400 S
SANDY UT
84092-5426
US

IV. Provider business mailing address

688 E VINE ST STE 14
MURRAY UT
84107-5541
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-6556
  • Fax:
Mailing address:
  • Phone: 801-436-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8337120-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: