Healthcare Provider Details

I. General information

NPI: 1538378922
Provider Name (Legal Business Name): JESSICA STEARNS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/10/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 UNION PARK AVE SUITE 600 OFFICE 679
COTTONWOOD HEIGHTS UT
84047
US

IV. Provider business mailing address

6170 MOUNTAIN VIEW DR
PARK CITY UT
84098-6123
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9006
  • Fax:
Mailing address:
  • Phone: 419-610-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016806
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number34.009849CTR
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number34.009849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: