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General NPI Number Information
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NPI Number | 1508566860
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Entity Type | Individual
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Provider Name | JESSIE KATHLEEN CHISCHILLIE FNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 1248 E 90 N STE 300
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2956
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Country | US
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Telephone | 801-765-9635
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Fax |
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Provider Business Mailing Address
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Address Line | 740 N 100 W
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2117
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Country | US
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Telephone | 509-251-5832
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 7658870
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License Number State | UT
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