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General NPI Number Information
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NPI Number | 1295255701
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Entity Type | Individual
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Provider Name | JEREMY RATLIFF APRN FNP
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Gender | Male
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 145 W 200 N STE 600
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City | PROVO
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State | UT
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Zip | 84601-3016
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Country | US
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Telephone | 801-821-2781
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Fax | 801-901-1194
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Provider Business Mailing Address
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Address Line | 145 W 200 N STE 600
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City | PROVO
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State | UT
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Zip | 84601-3016
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Country | US
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Telephone | 801-821-2781
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Fax | 801-901-1194
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5130849-4405
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License Number State | UT
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