Healthcare Provider Details

I. General information

NPI: 1861183022
Provider Name (Legal Business Name): LORI K JARDINE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E RIVERSIDE DR STE 102
SAINT GEORGE UT
84790-7122
US

IV. Provider business mailing address

393 E RIVERSIDE DR STE 102
SAINT GEORGE UT
84790-7122
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-5616
  • Fax: 435-500-0015
Mailing address:
  • Phone: 435-703-5616
  • Fax: 435-500-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9645160-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9645160-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: