Individual
HALEY W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1900 N STATE ST, PROVO, UT 84604-1341
(801) 373-2001
Mailing address
273 N 1325 W, SPRINGVILLE, UT 84663-3283
(385) 450-4572
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11336450-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/16/2018
Last updated
07/15/2021
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