Active NPI
Grace Ellen Moore, RDN
- Registered Dietitian
- South Jordan, UT
National Provider Identifier
1164022919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86051484
- Practice address
- 5126 W Daybreak Pkwy
South Jordan, UT 84009-5994 - Phone
- (443) 299-9623
- NPI assigned
- Oct 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86051484 | MD | Primary |
Addresses
Primary practice location
5126 W Daybreak Pkwy
South Jordan, UT 84009-5994
Mailing address
1305 N Valentine St
Salt Lake City, UT 84116-3627
Phone (443) 299-9623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86051484 | MD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710288000000",
"number": "1164022919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 N VALENTINE ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841163627",
"telephone_number": "443-299-9623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5126 W DAYBREAK PKWY",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840095994",
"telephone_number": "443-299-9623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "GRACE",
"middle_name": "ELLEN",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-30",
"last_updated": "2024-03-13",
"certification_date": "2024-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "86051484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.