Provider Demographics
NPI:1568941284
Name:PRICE, JARED (NP-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10084 N 5800 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9115
Mailing Address - Country:US
Mailing Address - Phone:801-808-7288
Mailing Address - Fax:
Practice Address - Street 1:610 S 850 E STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3946
Practice Address - Country:US
Practice Address - Phone:385-367-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11060885-1205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner