Healthcare Provider Details

I. General information

NPI: 1184559577
Provider Name (Legal Business Name): KATHERINE JOURDAN CHURCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5542 W TURIN LN
HIGHLAND UT
84003-4804
US

IV. Provider business mailing address

5542 W TURIN LN
HIGHLAND UT
84003-4804
US

V. Phone/Fax

Practice location:
  • Phone: 480-266-1347
  • Fax:
Mailing address:
  • Phone: 480-266-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8883289-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: