Healthcare Provider Details

I. General information

NPI: 1245910157
Provider Name (Legal Business Name): JORDAN MACKEY FNP, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 E DRAPER PKWY
DRAPER UT
84020-9095
US

IV. Provider business mailing address

2232 W PINNACLE AVE
MAPLETON UT
84664-3251
US

V. Phone/Fax

Practice location:
  • Phone: 435-447-4066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11267888-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: