Provider Demographics
NPI:1780302158
Name:JEFFERIES, GARRETT TANNER
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:TANNER
Last Name:JEFFERIES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W 500 S # 217
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6230
Mailing Address - Country:US
Mailing Address - Phone:540-809-8858
Mailing Address - Fax:
Practice Address - Street 1:533 W 2600 S STE 340
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7768
Practice Address - Country:US
Practice Address - Phone:801-683-9335
Practice Address - Fax:385-300-1842
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11454012-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty