Healthcare Provider Details

I. General information

NPI: 1063239119
Provider Name (Legal Business Name): ASHLYN RUDD MCCLELLAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W SOUTH JORDAN PKWY STE 450
SOUTH JORDAN UT
84095-3946
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 801-919-3008
  • Fax:
Mailing address:
  • Phone: 801-354-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14037948-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: