Healthcare Provider Details

I. General information

NPI: 1508460841
Provider Name (Legal Business Name): JENTRY CORA MCKELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENTRY CORA LEE RN

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 110
VINEYARD UT
84059-7509
US

IV. Provider business mailing address

1664 S DIXIE DR STE E102
ST GEORGE UT
84770-7329
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-0246
  • Fax: 385-203-0245
Mailing address:
  • Phone: 435-703-9647
  • Fax: 435-703-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7684329-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: