Provider Demographics
NPI:1013466978
Name:YARRINGTON, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:YARRINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 S 1560 W
Mailing Address - Street 2:STE B
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:435-882-2350
Mailing Address - Fax:435-882-2039
Practice Address - Street 1:2356 N 400 E
Practice Address - Street 2:STE 201
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3409
Practice Address - Country:US
Practice Address - Phone:435-882-2350
Practice Address - Fax:435-882-2039
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10068471-8002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant