Provider Demographics
NPI:1306269394
Name:SEAGROVE, JEFFREY P (MSN, APRN, PMHNP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:P
Last Name:SEAGROVE
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP
Other - Prefix:MR
Other - First Name:FREY
Other - Middle Name:P
Other - Last Name:SEAGROVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, PMHNP
Mailing Address - Street 1:419 E 200 S
Mailing Address - Street 2:APT. #19
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2128
Mailing Address - Country:US
Mailing Address - Phone:801-360-4002
Mailing Address - Fax:
Practice Address - Street 1:860 E 4500 S
Practice Address - Street 2:SUITE #302
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3002
Practice Address - Country:US
Practice Address - Phone:801-268-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7897695-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health