Healthcare Provider Details

I. General information

NPI: 1437935384
Provider Name (Legal Business Name): JACOB HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 W HIGHWAY 40
VERNAL UT
84078-2923
US

IV. Provider business mailing address

PO BOX 37
VERNAL UT
84078-0001
US

V. Phone/Fax

Practice location:
  • Phone: 435-790-2757
  • Fax: 435-789-4045
Mailing address:
  • Phone: 435-790-2757
  • Fax: 435-789-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: