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General NPI Number Information
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NPI Number | 1245910157
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Entity Type | Individual
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Provider Name | JORDAN MACKEY FNP, APRN
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Gender | Male
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 1132 E DRAPER PKWY
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City | DRAPER
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State | UT
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Zip | 84020-9095
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Country | US
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Telephone | 435-447-4066
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Fax |
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Provider Business Mailing Address
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Address Line | 2232 W PINNACLE AVE
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City | MAPLETON
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State | UT
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Zip | 84664-3251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11267888-4405
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License Number State | UT
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