Healthcare Provider Details

I. General information

NPI: 1568788495
Provider Name (Legal Business Name): JESSICA MICHELLE JONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W COUGAR BLVD
PROVO UT
84604-3311
US

IV. Provider business mailing address

395 W COUGAR BLVD
PROVO UT
84604-3311
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7525
  • Fax:
Mailing address:
  • Phone: 801-357-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number8674115-8905
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8674115-8905
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: