Healthcare Provider Details

I. General information

NPI: 1285199661
Provider Name (Legal Business Name): JENNIFER A PRESTON L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RED CLIFFS DR STE 36
ST GEORGE UT
84790-8129
US

IV. Provider business mailing address

1884 W 1700 N
ST GEORGE UT
84770-4716
US

V. Phone/Fax

Practice location:
  • Phone: 801-644-5576
  • Fax:
Mailing address:
  • Phone: 801-644-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11055212-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: