Healthcare Provider Details

I. General information

NPI: 1003732827
Provider Name (Legal Business Name): JESSICA BOOTHE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3668 W 2150 N STE 300
LEHI UT
84048-7800
US

IV. Provider business mailing address

8833 S OLD US HIGHWAY 189 # 74
PROVO UT
84604-6120
US

V. Phone/Fax

Practice location:
  • Phone: 385-287-7453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14287593
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: