Active NPI
Jamie Kingdon
- Prevention Professional
- North Salt Lake, UT
National Provider Identifier
1023549268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 119740-2401
- Practice address
- 652 Eaglepointe Dr
North Salt Lake, UT 84054-2643 - Phone
- (801) 638-7785
- NPI assigned
- Mar 21, 2017
- Last updated
- Mar 21, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 119740-2401 | UT | Primary |
Addresses
Primary practice location
652 Eaglepointe Dr
North Salt Lake, UT 84054-2643
Mailing address
652 Eaglepointe Dr
North Salt Lake, UT 84054-2643
Phone (801) 638-7785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119740-2401 | UT | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490054400000",
"number": "1023549268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "652 EAGLEPOINTE DR",
"city": "NORTH SALT LAKE",
"state": "UT",
"postal_code": "840542643",
"telephone_number": "801-638-7785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 EAGLEPOINTE DR",
"city": "NORTH SALT LAKE",
"state": "UT",
"postal_code": "840542643",
"telephone_number": "801-638-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINGDON",
"first_name": "JAMIE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-21",
"last_updated": "2017-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "UT",
"license": "119740-2401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.