Provider Demographics
NPI:1457514812
Name:JEWETT, JESS HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:JESS
Middle Name:HENRY
Last Name:JEWETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 COTTAGE CT
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-4700
Mailing Address - Country:US
Mailing Address - Phone:601-906-0152
Mailing Address - Fax:
Practice Address - Street 1:458 COTTAGE CT
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-4700
Practice Address - Country:US
Practice Address - Phone:601-984-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7946419-1205207P00000X
MS720-L146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine