Healthcare Provider Details

I. General information

NPI: 1558910927
Provider Name (Legal Business Name): JORDAN TRENT TATTON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HWY 123
SUNNYSIDE UT
84539
US

IV. Provider business mailing address

331 HWY 123
SUNNYSIDE UT
84539
US

V. Phone/Fax

Practice location:
  • Phone: 435-888-4411
  • Fax: 435-888-2270
Mailing address:
  • Phone: 435-888-4411
  • Fax: 435-888-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9808028-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: