NPIMap

Organization Active NPI

Legacy Medical Group, LLC

  • Nurse Practitioner
  • Taylorsville, UT
National Provider Identifier
1447621685
Registry record updated Nov 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LEGACY MEDICAL GROUP, LLC
Practice address
1020 W Atherton Dr
Suite 220
Taylorsville, UT 84123-3470
Phone
(801) 833-0000
Fax
(801) 833-0001
NPI assigned
Oct 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristina Mosley-Carter
Title
Executive Director
Phone
(801) 833-0000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1020 W Atherton Dr
Suite 220
Taylorsville, UT 84123-3470

Mailing address

1020 W Atherton Dr
Suite 220
Taylorsville, UT 84123-3470
Phone (801) 833-0000

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447027200000",
    "number": "1447621685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 W ATHERTON DR",
            "address_2": "SUITE 220",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841233470",
            "telephone_number": "801-833-0000",
            "fax_number": "801-833-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 W ATHERTON DR",
            "address_2": "SUITE 220",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841233470",
            "telephone_number": "801-833-0000",
            "fax_number": "801-833-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-14",
        "last_updated": "2015-11-09",
        "status": "A",
        "authorized_official_last_name": "MOSLEY-CARTER",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-833-0000"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorsville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.