Healthcare Provider Details

I. General information

NPI: 1275453581
Provider Name (Legal Business Name): JENNIFER CLOUGH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S FAIRGROUNDS RD
PRICE UT
84501-4207
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-636-3739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9517125-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: