Healthcare Provider Details

I. General information

NPI: 1699927418
Provider Name (Legal Business Name): CHRISTY JORGENSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 N 500 W
PROVO UT
84601-1548
US

IV. Provider business mailing address

585 N 500 W
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-1801
  • Fax: 801-375-0369
Mailing address:
  • Phone: 801-374-1801
  • Fax: 12-168-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number199808-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: