Healthcare Provider Details

I. General information

NPI: 1861357725
Provider Name (Legal Business Name): JESSICA EMMA ANTUNEZ RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S LEFT FORK HOBBLE CREEK CYN
SPRINGVILLE UT
84663-6165
US

IV. Provider business mailing address

1457 E 1540 S
SPANISH FORK UT
84660-3512
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-6675
  • Fax: 801-358-6675
Mailing address:
  • Phone: 801-358-6675
  • Fax: 801-358-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number1264991-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: