| Doctor Name: | JESS ANDERSON |
| NPI Number: | 1922417831 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 4985757-4405 |
| Business Practice Address: | 3665 S 8400 W Magna, UT - 840444907 |
| Business Phone Number: | 8012509638 |
| Business Fax Number: | |
| Mailing Address: | 3665 S 8400 W, MAGNA |
| State: | UT |
| Postal Code: | 840444907 |
| Phone Number: | 8012509638 |
| Fax Number: | |
| NPI Enumeration Date: | 08/05/2014 |
| NPI Last Update Date: | 08/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4985757-4405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |