Provider Demographics
NPI:1558109504
Name:PUTNAM, JODI LYN (FNP-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYN
Last Name:PUTNAM
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 NORTH MAIN ST
Mailing Address - Street 2:STE 1B
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660
Mailing Address - Country:US
Mailing Address - Phone:385-518-0403
Mailing Address - Fax:385-518-0466
Practice Address - Street 1:1416 NORTH MAIN ST
Practice Address - Street 2:STE 1B
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660
Practice Address - Country:US
Practice Address - Phone:385-518-0403
Practice Address - Fax:385-518-0466
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7992533-4405363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner