Caitlin Randi Clark, FNP
Individual provider Active NPI Family Nurse Practitioner · Midvale, UT
NPI 1376421883 · NPPES record last updated Sep 24, 2025
Key facts
- NPI
- 1376421883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 12591240-8900 (UT)
- Practice address
- 623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529 - Phone
- (801) 261-9490
- NPI assigned
- Aug 22, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
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
Hospital & facility affiliations
- Refined Healthcare Services LLC
- Refined Hospice LLC
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 |
|---|---|---|---|---|
| I20251029002455 | UT | Practitioner - Nurse Practitioner | 4486143583 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12591240-8900 | UT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Mobile Medicine LLC | Family | Current |
Accepting new patients |
Locations
623 E Fort Union Blvd
Ste 105
Midvale, UT 84047
Phone (385) 412-1660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 12591240-8900 | UT | Yes |
Addresses
Primary practice location
623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529
Mailing address
1711 Grant Ave
Ogden, UT 84404-5730
Phone (801) 643-8225
Other providers in Midvale, UT
- Johanna Isabel Christensen
- Kristie Marie Christofferson
- Chrysalis Counseling Center, L.L.C.
- Payton Marie Cioffi
- Allison Grace Cirenza
- Kynzie Clark
- Jeffrey W. Cline
- Bridgette Ann Clonts
- Clubhouse Pediatric Dentistry of West Jordan
- Carla Coates
All providers in Midvale, UT · Family 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.