Healthcare Provider Details

I. General information

NPI: 1952265738
Provider Name (Legal Business Name): JODIE LYNN REINER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W 3300 S
SOUTH SALT LAKE UT
84119-3325
US

IV. Provider business mailing address

7611 S UNION PARK AVE APT C104
SANDY UT
84047-3028
US

V. Phone/Fax

Practice location:
  • Phone: 801-583-2500
  • Fax:
Mailing address:
  • Phone: 530-919-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12075018-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: