Provider Demographics
NPI:1801356530
Name:MOSTELLER, JENNIFER CARTER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARTER
Last Name:MOSTELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 N 400 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2321
Mailing Address - Country:US
Mailing Address - Phone:801-262-7246
Mailing Address - Fax:801-262-3442
Practice Address - Street 1:1219 N 400 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2321
Practice Address - Country:US
Practice Address - Phone:435-565-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9765586-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner