Jessie Haderlie

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

11767125-4405 Issued in UT

Practice address

5573 W Bluevail CT
West Jordan, UT 84081-5226

Phone

(801) 419-9365

NPI assigned

Aug 27, 2024

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smile Psychiatry and Behavioral

  • Psychiatry Physician
  • Draper, UT
  • NPI 1043970262

  Psychiatry, UT

  Medicare reassignment NPD

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 20, 2025.

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1699509257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5573 W BLUEVAIL CT",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840815226",
            "telephone_number": "801-419-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5573 W BLUEVAIL CT",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840815226",
            "telephone_number": "801-419-9365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADERLIE",
        "first_name": "JESSIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-27",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "UT",
            "license": "11767125-4405",
            "primary": true
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "UT",
            "license": "11767125-3102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vance King Gunnell
• Ingrid Gustafson-Porritt
• Bonnie Guthrie
• Angel Gutierrez
• Erin Guymon
• Alec Hale
• Diarmid Ian Hall, DMD
• Samuel David Hall
• Shandria Hall
• Hallelujah Home Health LLC

• All providers in West Jordan, UT
• Psychiatric/Mental Health Registered Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.