Provider Demographics
NPI:1295255701
Name:RATLIFF, JEREMY (APRN FNP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12427 S PASTURE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5608
Mailing Address - Country:US
Mailing Address - Phone:725-292-7014
Mailing Address - Fax:385-331-4038
Practice Address - Street 1:12427 S PASTURE RD STE 104
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-5608
Practice Address - Country:US
Practice Address - Phone:801-727-8744
Practice Address - Fax:801-727-8743
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF05170659363LF0000X
UT5130849-4405363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily