Healthcare Provider Details

I. General information

NPI: 1174448682
Provider Name (Legal Business Name): JORDAN HADLEY BIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD
LEHI UT
84043-7186
US

IV. Provider business mailing address

4471 WESTERN GAILS CT UNIT 505
FORT MYERS FL
33916-8025
US

V. Phone/Fax

Practice location:
  • Phone: 385-345-3000
  • Fax:
Mailing address:
  • Phone: 385-204-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1207966-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: