Healthcare Provider Details

I. General information

NPI: 1457514812
Provider Name (Legal Business Name): JESS HENRY JEWETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 COTTAGE CT
PROVIDENCE UT
84332-4700
US

IV. Provider business mailing address

458 COTTAGE CT
PROVIDENCE UT
84332-4700
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5570
  • Fax:
Mailing address:
  • Phone: 601-906-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number720-L
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number7946419-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: