Provider Demographics
NPI:1386399467
Name:CHANDLER, JORDYN
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:CHANDLER
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 1:3942 S 3450 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2094
Mailing Address - Country:US
Mailing Address - Phone:801-391-3841
Mailing Address - Fax:
Practice Address - Street 1:1868 N 1200 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1939
Practice Address - Country:US
Practice Address - Phone:801-614-9030
Practice Address - Fax:801-614-9040
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12642400-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant