Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Mozingo

Individual provider Family Nurse Practitioner · NPI 1295347474

Shane Mozingo is a Nurse Practitioner in North Logan, Utah. Qualified in 2023, 3 years ago. Practices with Atlas Medical Alaska LLC, a 6-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Utah.

Years since qualifying
3
Licensed in
UT
In the registry since
2020

Practice location Address checks out

2841 N 920 E
North Logan, UT 84341-5806
Phone: (435) 512-1066
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 10646550-3102 (UT)

Record details

NPI number1295347474
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 19, 2020
Last updated in NPPESDecember 14, 2020
Certification dateDecember 14, 2020
Mailing address2841 N 920 E, North Logan, UT 84341-5806

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Atlas Medical Alaska Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in North Logan