Healthcare Provider Details

I. General information

NPI: 1558109504
Provider Name (Legal Business Name): JODI LYN PUTNAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 NORTH MAIN ST STE 1B
SPANISH FORK UT
84660
US

IV. Provider business mailing address

84 S STATE ST
FOUNTAIN GREEN UT
84632-7640
US

V. Phone/Fax

Practice location:
  • Phone: 385-518-0403
  • Fax: 385-518-0466
Mailing address:
  • Phone: 435-445-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7992533-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7992533-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: