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General NPI Number Information
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NPI Number | 1891675021
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Entity Type | Organization
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Legal Business Name | CANYON CREEK HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 245 E 400 S
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City | SPRINGVILLE
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State | UT
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Zip | 84663-1957
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Country | US
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Telephone | 385-543-5266
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Fax | 385-503-2493
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Provider Business Mailing Address
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Address Line | 245 E 400 S
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City | SPRINGVILLE
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State | UT
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Zip | 84663-1957
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Country | US
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Telephone | 385-543-5266
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Fax | 385-503-2493
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | JENTRY CORA MCKELL
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Credential | NP
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Telephone | 801-310-5878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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