Tara Rose Agee
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Salt Lake City, UT
NPI 1366315541 · NPPES record last updated Sep 24, 2025
Key facts
- NPI
- 1366315541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0000000 (UT)
- Practice address
- 500 Foothill Blvd
Salt Lake City, UT 84148-0002 - Phone
- (801) 582-1565
- NPI assigned
- Sep 24, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mindful Mobile Medicine LLC
Practice addresses (Care Compare)
623 E Fort Union Blvd
Suite 105
Midvale, UT 84047-5529
Phone (385) 412-1660
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260303002410 | UT | Practitioner - Nurse Practitioner | 5890277503 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000000 | UT | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Mobile Medicine LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0000000 | UT | Yes |
Addresses
Primary practice location
500 Foothill Blvd
Salt Lake City, UT 84148-0002
Mailing address
500 Foothill Blvd
Salt Lake City, UT 84148-0002
Phone (801) 582-1565
Other providers in Salt Lake City, UT
- Cori Ann Agarwal
- Jayant Prasad Agarwal
- Neeraj Agarwal
- Tejita Agarwal
- Mary Kathleen K. Agarwala
- Corrie Frances Agnew
- Christian David Friedrich Agricola
- Cristina Aguayo Romero
- Amanda Nichole Lomeli Aguda
- Agueda Hubbard LLC
All providers in Salt Lake City, UT · Psychiatric/Mental Health Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.