Provider Demographics
NPI:1992565246
Name:STONE, JENNIFER JILL (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:STONE
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 S CHADBOURNE DR # B
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5809
Mailing Address - Country:US
Mailing Address - Phone:603-545-4844
Mailing Address - Fax:
Practice Address - Street 1:7926 S CHADBOURNE DR # B
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5809
Practice Address - Country:US
Practice Address - Phone:603-545-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13410138-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health