MEDICARE: MELODY FORSYTH APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4934951-4405	UT

General Provider Information

NPI Number	:	1588496533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY FORSYTH APRN

Provider Business Mailing Address
First Line	:	9289 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9289 S REDWOOD RD STE C
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6731
Country	:	US
Telephone Number	:	801-568-2898
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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Directions to “ MELODY FORSYTH APRN” Practice Location

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