Provider Demographics
NPI:1376796771
Name:MANNING, JEFFERY LYNN (F-NP)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LYNN
Last Name:MANNING
Suffix:
Gender:M
Credentials:F-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 N 4800 W
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9489
Mailing Address - Country:US
Mailing Address - Phone:801-731-7227
Mailing Address - Fax:
Practice Address - Street 1:1396 N 4800 W
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:UT
Practice Address - Zip Code:84404-9489
Practice Address - Country:US
Practice Address - Phone:801-731-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5074276-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily