MEDICARE: KAPRENA MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1295424158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAPRENA MOORE

Provider Business Mailing Address
First Line	:	717 E 3230 N
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-4727
Country	:	US
Telephone Number	:	385-241-1046
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 N CANYON RD STE 204
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-5608
Country	:	US
Telephone Number	:	385-241-1046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/04/2023

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Directions to “ KAPRENA MOORE ” Practice Location

Language	Start Address	Practice Location

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