Provider Demographics
NPI:1881803237
Name:JACOBSON, BECKY J (NP APRN)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:J
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:NP APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:HEDDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2853 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0463
Mailing Address - Country:US
Mailing Address - Phone:801-399-4263
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 4625
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-387-4800
Practice Address - Fax:801-387-4805
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2112744405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner