Healthcare Provider Details

I. General information

NPI: 1912480567
Provider Name (Legal Business Name): VALARIE D JACOBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST
BOUNTIFUL UT
84010-6236
US

IV. Provider business mailing address

726 S KAYS DR
KAYSVILLE UT
84037-8402
US

V. Phone/Fax

Practice location:
  • Phone: 801-784-8414
  • Fax: 385-213-0093
Mailing address:
  • Phone: 801-784-8414
  • Fax: 801-701-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348597-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number348597-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: