Provider Demographics
NPI:1700427382
Name:NIELSON, JESSINNA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSINNA
Middle Name:
Last Name:NIELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S 2300 W
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-5404
Mailing Address - Country:US
Mailing Address - Phone:801-602-1981
Mailing Address - Fax:
Practice Address - Street 1:722 SHEPARD LN STE 102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3845
Practice Address - Country:US
Practice Address - Phone:385-988-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5798263-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily