Healthcare Provider Details

I. General information

NPI: 1306269394
Provider Name (Legal Business Name): JEFFREY P SEAGROVE-NELSON MSN, APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FREY P SEAGROVE-NELSON MSN, APRN, PMHNP

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1422 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 801-360-4002
  • Fax: 801-465-1917
Mailing address:
  • Phone: 801-360-4002
  • Fax: 801-465-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7897695-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: