# MINDFUL MOBILE MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245068626
- **Authorized official:** TYLER YOUNG (VP)
- **Authorized official phone:** (801) 879-2664

## Contact information

- **Practice address:** 623 E FORT UNION BLVD STE 105, MIDVALE, UT 84047-5529
- **Practice address phone:** (801) 879-2664
- **Mailing address:** 623 E FORT UNION BLVD STE 105, MIDVALE, UT 84047-5529
- **Mailing address phone:** (385) 412-1660
- **Mailing address fax:** (801) 261-5856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/25/2024
- **Last updated:** 02/10/2025