Koleton Michael Moon
Individual provider Active NPI Community Health Worker · Manti, UT
NPI 1033690201 · NPPES record last updated Aug 27, 2018
Key facts
- NPI
- 1033690201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 920 N. 000 W.
Manti, UT 84642 - Phone
- (435) 835-4316
- Fax
- (435) 835-4317
- NPI assigned
- Aug 27, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth Health Associates, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
920 N. 000 W.
Manti, UT 84642
Mailing address
299 N 200 W
Bountiful, UT 84010-7043
Phone (801) 815-3443
Other providers in Manti, UT
- Main Street Clinic LLC
- Manti Ambulance Association
- Manti Family Dental Clinic
- Michael McQuivey
- Lauren Linn Miller
- Sheri Morris
- New Beginnings Family Counseling
- Charles Albert Noyes
- Camilla Olsen
- Sean Lucien Olsen
All providers in Manti, UT · Community Health Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.