Provider Demographics
NPI:1114579596
Name:FENTON, JAMES EDWARD JR (FNP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:FENTON
Suffix:JR
Gender:M
Credentials:FNP
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Mailing Address - Street 1:3841 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1319
Mailing Address - Country:US
Mailing Address - Phone:217-779-3606
Mailing Address - Fax:
Practice Address - Street 1:600 S STATE ST STE 2
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1210
Practice Address - Country:US
Practice Address - Phone:385-483-1003
Practice Address - Fax:386-222-7279
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA155585363LF0000X
IL209.019352363LF0000X
UT11425353-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily