Provider Demographics
NPI:1447904313
Name:MUCHMORE, MICHELE (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MUCHMORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2317
Mailing Address - Country:US
Mailing Address - Phone:801-386-5600
Mailing Address - Fax:
Practice Address - Street 1:3903 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2317
Practice Address - Country:US
Practice Address - Phone:801-387-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT288517-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8760003008007Medicaid
UT260022408OtherRAILROAD MEDICARE
UT000055266OtherMEDICARE PIN