MEDICARE: RAEGAN MCCLYMONT RN

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	163WC0200X	Critical Care Medicine Registered Nurse	14242962-3102	UT

General Provider Information

NPI Number	:	1477404820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEGAN MCCLYMONT RN

Provider Business Mailing Address
First Line	:	1025 E OLYMPUS RIDGE CV APT G105
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-5696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5131 S COTTONWOOD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:	801-507-3800
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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