Healthcare Provider Details

I. General information

NPI: 1417894833
Provider Name (Legal Business Name): JONICA WHITMORE-HALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

IV. Provider business mailing address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

V. Phone/Fax

Practice location:
  • Phone: 801-205-9429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5067686-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: