Healthcare Provider Details

I. General information

NPI: 1124799770
Provider Name (Legal Business Name): HAYLEY ALECE JOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 103
AMERICAN FORK UT
84003-2954
US

IV. Provider business mailing address

534 E 1640 N
OREM UT
84097-7333
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-9560
  • Fax:
Mailing address:
  • Phone: 801-319-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5295479-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: