Healthcare Provider Details

I. General information

NPI: 1083480701
Provider Name (Legal Business Name): LONNIE JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S MAIN ST
LAYTON UT
84041-7135
US

IV. Provider business mailing address

380 S 200 W
FARMINGTON UT
84025-2409
US

V. Phone/Fax

Practice location:
  • Phone: 801-336-1845
  • Fax:
Mailing address:
  • Phone: 435-282-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: