Healthcare Provider Details

I. General information

NPI: 1033990908
Provider Name (Legal Business Name): JAYCEE LYN FAUSETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N 400 W ST B-6
OREM UT
84057
US

IV. Provider business mailing address

153 N 400 W ST B-6
OREM UT
84057
US

V. Phone/Fax

Practice location:
  • Phone: 801-921-2260
  • Fax:
Mailing address:
  • Phone: 801-616-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10514537-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: