Healthcare Provider Details

I. General information

NPI: 1356755094
Provider Name (Legal Business Name): JASON JON NAKKEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 N UNIVERSITY AVE STE 105
PROVO UT
84604-6601
US

IV. Provider business mailing address

280 S MAIN ST
BOUNTIFUL UT
84010-6236
US

V. Phone/Fax

Practice location:
  • Phone: 801-356-6100
  • Fax:
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number11085893-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP1-0050303
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11085893-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: