Provider Demographics
NPI:1609501329
Name:SUTHERLAND, JESSICA ERIN (DNP, PMHNP, RN)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ERIN
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DNP, PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6476 N FLAT TOP DR
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1220
Mailing Address - Country:US
Mailing Address - Phone:801-897-9432
Mailing Address - Fax:435-850-1911
Practice Address - Street 1:1929 N AARON DR STE I
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8112
Practice Address - Country:US
Practice Address - Phone:435-850-1823
Practice Address - Fax:435-850-1911
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT10862079-4405363LP0808X
UT10862079-3102163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health