Healthcare Provider Details

I. General information

NPI: 1508442518
Provider Name (Legal Business Name): NATHANIEL WILLIAM JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S WAKARA WAY RM A0058
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

590 S WAKARA WAY RM A0058
SALT LAKE CITY UT
84108-1200
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-5457
  • Fax:
Mailing address:
  • Phone: 801-587-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14279035-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: