DUKE FAMILY & WELLNESS – Family Nurse Practitioner, NPI 1104390111
Family Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DUKE FAMILY & WELLNESS
2473, Beverly Street, Sugar House, Salt Lake City, Salt Lake County, Utah, 84106, United States
SALT LAKE CITY, UT 841063116
Phone: (801) 695-7587
Fax: (866) 777-7550
Type: Location
1448 N 2000 W STE 3
CLINTON, UT 840158388
Phone: (801) 695-7587
Fax: (855) 965-0961
Type: Location
1448 N 2000 W Ste 3
Clinton, UT 840158388
Phone: (801) 695-7587
Fax: (855) 965-0961
Type: Location
2561, South 1560 West, Woods Cross, Davis County, Utah, 84087, United States
WOODS CROSS, UT 840872361
Phone: (801) 505-0821
Fax: (801) 505-0803
Type: Mailing
2909 WASHINGTON BLVD STE 248
OGDEN, UT 844013744
Phone: (801) 603-3246
Fax: (801) 797-0235
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-07-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-02-28 (99 days ago).
Enrollment records
1
Earliest due date
2026-02-28
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20190703002097 | O | Clinic/Group Practice | UT | 2026-02-28 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84106)
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