Healthcare Provider Details

I. General information

NPI: 1144620691
Provider Name (Legal Business Name): JESSICA NICOLE ARMENTOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3337
US

IV. Provider business mailing address

1034 N 500 W
PROVO UT
84604-3337
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7860
  • Fax:
Mailing address:
  • Phone: 801-858-3461
  • Fax: 801-955-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9643733-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: