MEDICARE: RENEWRX

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

General Provider Information

NPI Number	:	1639021447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWRX

Provider Business Mailing Address
First Line	:	6065 S HIGHLAND DR STE 1
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-1381
Country	:	US
Telephone Number	:	801-893-6725
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 S HIGHLAND DR STE 1
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-1381
Country	:	US
Telephone Number	:	801-893-6725
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TYLER COE
Credential	:	NP
Telephone Number	:	801-893-6725

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “RENEWRX ” Practice Location

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