Healthcare Provider Details

I. General information

NPI: 1639086655
Provider Name (Legal Business Name): JESSICA ANN DALLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 N 2480 W
HURRICANE UT
84737-3515
US

IV. Provider business mailing address

562 N 2480 W
HURRICANE UT
84737-3515
US

V. Phone/Fax

Practice location:
  • Phone: 909-251-9511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11758620-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: