Individual
COLTON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
555 W STATE ROAD 164, SALEM, UT 84653-5732
(385) 203-2720
(801) 798-8961
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9420231-4405
UT
Other
Enumeration date
10/04/2024
Last updated
10/04/2024
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