Healthcare Provider Details

I. General information

NPI: 1689502239
Provider Name (Legal Business Name): GABRIELA CLARK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 E 10 S
SPANISH FORK UT
84660-6221
US

IV. Provider business mailing address

2929 E 10 S
SPANISH FORK UT
84660-6221
US

V. Phone/Fax

Practice location:
  • Phone: 801-800-2799
  • Fax:
Mailing address:
  • Phone: 801-800-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: