Healthcare Provider Details

I. General information

NPI: 1952035750
Provider Name (Legal Business Name): JESSICA DECKART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

IV. Provider business mailing address

752 W STEPHENS VIEW WAY
DRAPER UT
84020-8422
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax: 801-567-9826
Mailing address:
  • Phone: 801-918-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number8752080-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: