Healthcare Provider Details

I. General information

NPI: 1023285459
Provider Name (Legal Business Name): JENACA WILSON BEAGLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 N STATE ST
OREM UT
84057-2025
US

IV. Provider business mailing address

1790 N STATE ST
OREM UT
84057-2025
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-8255
  • Fax: 801-224-8301
Mailing address:
  • Phone: 801-224-8255
  • Fax: 801-224-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number4552629-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4552629-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: