=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912851049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPOWERING VITALITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S MAIN ST STE 2
-----------------------------------------------------
City | TOOELE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84074-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-673-5756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 W DELGADA LN
-----------------------------------------------------
City | STANSBURY PARK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84074-4034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-673-5756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/ OWNER
-----------------------------------------------------
Name | KEARSTA WASHBURN
-----------------------------------------------------
Credential | DNP, FNP-C, ACHPN
-----------------------------------------------------
Telephone | 801-673-5756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------