Healthcare Provider Details

I. General information

NPI: 1083309645
Provider Name (Legal Business Name): JESSICA ANN FRAUGHTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN HALL

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 05/15/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N 1100 E
AMERICAN FORK UT
84003-2096
US

IV. Provider business mailing address

770 E 1530 S
LEHI UT
84043-5509
US

V. Phone/Fax

Practice location:
  • Phone: 801-855-3337
  • Fax:
Mailing address:
  • Phone: 801-874-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10648526-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10648526-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number10648526-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: