MEDICARE: JASON JON NAKKEN D.O.

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	208VP0014X	Interventional Pain Medicine Physician	11085893-1204	UT
2	207L00000X	Anesthesiology Physician	BP1-0050303	TX
3	207L00000X	Anesthesiology Physician	11085893-1204	UT

General Provider Information

NPI Number	:	1356755094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON JON NAKKEN D.O.

Provider Business Mailing Address
First Line	:	280 S MAIN ST
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-6236
Country	:	US
Telephone Number	:	801-505-0821
Fax Number	:	801-505-0803

Provider Business Practice Location Address
First Line	:	3585 N UNIVERSITY AVE STE 105
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6601
Country	:	US
Telephone Number	:	801-356-6100
Fax Number	:

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/04/2026

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