MEDICARE: MELISSA RADCLIFFE APNP

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	363LF0000X	Family Nurse Practitioner	294542-4405	UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	294542-4405	UT

General Provider Information

NPI Number	:	1992356240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA RADCLIFFE APNP

Provider Business Mailing Address
First Line	:	3780 S WEST TEMPLE STE 200
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4515
Country	:	US
Telephone Number	:	801-970-4205
Fax Number	:	385-202-3097

Provider Business Practice Location Address
First Line	:	3780 S WEST TEMPLE STE 200
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4515
Country	:	US
Telephone Number	:	801-970-4205
Fax Number	:	385-202-3097

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	07/16/2025

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