Healthcare Provider Details

I. General information

NPI: 1407228216
Provider Name (Legal Business Name): JARED ERICKSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 SHEPARD LN STE 200
FARMINGTON UT
84025-2974
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-6260
  • Fax: 801-397-6262
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7760523-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: