NICOLETTE MOORE APRN, FNP-BC
NPI 1114688819
Nurse Practitioner - Family in Salt Lake City, UT
About Nicolette Moore Aprn, Fnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NICOLETTE MOORE APRN, FNP-BC (NPI 1114688819) is an individual family provider in Salt Lake City, Utah, licensed in Utah (7487553-4405) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Nicolette Moore Aprn, Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Nicolette Moore reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Midvale, UT 84047
- Reassigned Medicare billing, Utah enrollment
- 3,691 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 84121 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SALT LAKE CITY, UT 84121
SALT LAKE CITY, UT 84121
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Nicolette Moore's NPI number?
The NPI number for Nicolette Moore is 1114688819. It was assigned to this individual provider in the NPPES registry on January 4, 2022.
Where is Nicolette Moore located?
Nicolette Moore practices at 1770 E Fort Union Blvd Ste 101, Salt Lake City, UT 84121. The listed phone number is (801) 997-8881.
What is Nicolette Moore's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Nicolette Moore enrolled in Medicare?
Yes. Nicolette Moore is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Nicolette Moore's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Nicolette Moore reassigns Medicare benefits to Ihc Health Services Inc (Midvale, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicolette Moore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Nicolette Moore was last updated on January 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Nicolette Moore, APRN, FNP-BC · NPI 1114688819
Family physician in Salt Lake City, Utah. Individual provider, active in the CMS NPPES registry since January 4, 2022.
## Identity
- **NPI:** 1114688819 (Entity type: Individual)
- **Enumerated:** January 4, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 7487553-4405 (Utah)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1770 E FORT UNION BLVD STE 101, Salt Lake City, UT 84121-2881
- **Phone:** (801) 997-8881
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Ihc Health Services Inc (NPI 1891810867, Midvale, UT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 4, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1114688819) · Data from the CMS NPPES public registry.