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NPI Code Detail

MEDICARE: LORI K JARDINE PMHNP-BC

MEDICARE: LORI K JARDINE 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
1363LF0000XFamily Nurse Practitioner9645160-4405UT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner9645160-4405UT

General Provider Information

NPI Number : 1861183022
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI K JARDINE PMHNP-BC
Provider Business Mailing Address
First Line : 1664 S DIXIE DR STE E102
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-7329
Country : US
Telephone Number : 435-703-9647
Fax Number : 435-703-6003
Provider Business Practice Location Address
First Line : 1664 S DIXIE DR STE E102
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-7329
Country : US
Telephone Number : 435-703-9647
Fax Number : 435-703-6003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2023
Last Update Date : 04/25/2025

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Directions to “ LORI K JARDINE PMHNP-BC” Practice Location

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