Healthcare Provider Details

I. General information

NPI: 1447193545
Provider Name (Legal Business Name): JSA NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 S SPARROW HAWK LN
HERRIMAN UT
84096-5735
US

IV. Provider business mailing address

138 E 12300 S # 282
DRAPER UT
84020-7976
US

V. Phone/Fax

Practice location:
  • Phone: 714-317-7065
  • Fax:
Mailing address:
  • Phone: 714-317-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ADAM PARKER
Title or Position: PRESIDENT
Credential:
Phone: 714-317-7065