Provider Demographics
NPI:1144668591
Name:JOHNSEN, JORDAN WYLER (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:WYLER
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 W 5400 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6835
Mailing Address - Country:US
Mailing Address - Phone:801-361-6787
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1272
Practice Address - Country:US
Practice Address - Phone:801-876-3749
Practice Address - Fax:801-876-3697
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6212698-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily