Healthcare Provider Details

I. General information

NPI: 1073231023
Provider Name (Legal Business Name): GINA KAY MANHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 W SOUTH JORDAN PKWY STE 237
SOUTH JORDAN UT
84095-3979
US

IV. Provider business mailing address

10380 S REDWOOD RD
SOUTH JORDAN UT
84095-4414
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5118
  • Fax:
Mailing address:
  • Phone: 701-876-9044
  • Fax: 385-831-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4792138900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-195947
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: