Healthcare Provider Details

I. General information

NPI: 1912429887
Provider Name (Legal Business Name): JESSE STOKES LLOYD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 W 2525 N
PLAIN CITY UT
84404-9228
US

IV. Provider business mailing address

3385 W 2525 N
PLAIN CITY UT
84404-9228
US

V. Phone/Fax

Practice location:
  • Phone: 801-644-5121
  • Fax:
Mailing address:
  • Phone: 801-644-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7669370-4405
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier7669370-4405
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: