Individual
MR. JESSE A JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1580 W ANTELOPE DR, SUITE 100, LAYTON, UT 84041-1160
(801) 927-1632
(801) 927-1591
Mailing address
1566 E 1700 S, SLC, UT 84105
(801) 773-8644
(775) 246-4186
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6124415-1206
UT
363A00000X
Physician Assistant
PA17883
CA
363A00000X
Physician Assistant
PA907
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505904
—
NV
01
—
CC7683
BCBS
NV
Enumeration date
11/03/2005
Last updated
10/29/2021
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