# CRESCENT HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780397224
- **Authorized official:** JAY KANSAGRA (CEO)
- **Authorized official phone:** (385) 438-3255

## Contact information

- **Practice address:** 11193 S REDWOOD RD STE 102N, SOUTH JORDAN, UT 84095-8208
- **Practice address phone:** (385) 438-3255
- **Practice address fax:** (385) 900-1234
- **Mailing address:** 11193 S REDWOOD RD STE 102N, SOUTH JORDAN, UT 84095-8208
- **Mailing address phone:** (385) 438-3255
- **Mailing address fax:** (385) 900-1234

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/29/2022
- **Last updated:** 01/06/2023