Provider Demographics
NPI:1417199506
Name:SELDEN, JONATHAN ANDREW (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:SELDEN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
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Mailing Address - Street 1:3885 W CAMPUS DR DEPT 1114
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84408-1114
Mailing Address - Country:US
Mailing Address - Phone:801-626-6406
Mailing Address - Fax:801-626-6541
Practice Address - Street 1:3885 W CAMPUS DR DEPT 1114
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-1114
Practice Address - Country:US
Practice Address - Phone:801-626-6406
Practice Address - Fax:801-626-6541
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5202228-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health