Healthcare Provider Details

I. General information

NPI: 1972172260
Provider Name (Legal Business Name): JACKIE BRINGHURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S 315 E
SALEM UT
84653-5845
US

IV. Provider business mailing address

1423 S 315 E
SALEM UT
84653-5845
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-9585
  • Fax:
Mailing address:
  • Phone: 801-367-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348575-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number348575-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: