Healthcare Provider Details

I. General information

NPI: 1649182296
Provider Name (Legal Business Name): JACOB DONALD WHITNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 W 2400 S
CEDAR CITY UT
84720-6706
US

IV. Provider business mailing address

340 W 1425 N APT 88
CEDAR CITY UT
84721-5016
US

V. Phone/Fax

Practice location:
  • Phone: 435-900-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: