Healthcare Provider Details

I. General information

NPI: 1376144402
Provider Name (Legal Business Name): MICHELLE EMIKO-OYA JENKINS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 VERNON DR
EAGLE MOUNTAIN UT
84005-4581
US

IV. Provider business mailing address

6343 VERNON DR
EAGLE MOUNTAIN UT
84005-4581
US

V. Phone/Fax

Practice location:
  • Phone: 385-232-9119
  • Fax:
Mailing address:
  • Phone: 385-232-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8197331-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: