MEDICARE: JESSICA LEE ANDERSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	7544866-4405	UT

General Provider Information

NPI Number	:	1063222065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEE ANDERSON RN

Provider Business Mailing Address
First Line	:	212 E CROSSROADS BLVD # 148
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-2966
Country	:	US
Telephone Number	:	801-688-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 RIVER PARK DR STE 255
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	801-616-3675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	12/09/2025

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