Provider Demographics
NPI:1275425001
Name:MOORE, MADISON TAYLOR (RD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:TAYLOR
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1551 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5707
Mailing Address - Country:US
Mailing Address - Phone:435-862-0896
Mailing Address - Fax:
Practice Address - Street 1:376 S 1080 W UNIT 203
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-4447
Practice Address - Country:US
Practice Address - Phone:435-862-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11027079-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered