Active NPI
Jared Vellinga
- Registered Nurse
- Salt Lake City, UT
National Provider Identifier
1093682205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 11758505-3102
- Practice address
- 500 Foothill Dr
Salt Lake City, UT 84148-0001 - Phone
- (801) 562-1565
- NPI assigned
- Oct 22, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 11758505-3102 | UT | Primary |
Addresses
Primary practice location
500 Foothill Dr
Salt Lake City, UT 84148-0001
Mailing address
3065 W 5825 S
Roy, UT 84067-1132
Phone (385) 519-3113
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11758505-3102 | UT | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1093682205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3065 W 5825 S",
"city": "ROY",
"state": "UT",
"postal_code": "840671132",
"telephone_number": "385-519-3113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 FOOTHILL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841480001",
"telephone_number": "801-562-1565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELLINGA",
"first_name": "JARED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-10-22",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "UT",
"license": "11758505-3102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.