MEDICARE: JONI LYBBERT DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	9819789-4405	UT

General Provider Information

NPI Number	:	1235817339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI LYBBERT DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	114 E 230 N
Second Line	:
City	:	VINEYARD
State	:	UT
Zip	:	84059-2903
Country	:	US
Telephone Number	:	404-713-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	12587 S FORT ST STE 202
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-9404
Country	:	US
Telephone Number	:	801-893-9564
Fax Number	:	801-893-9062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	08/28/2025

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