Search › Utah › 1041C0700X
Kennedy Jackson
NPI 1063338572 · on the registry since 2026 · sole proprietor
Practice
- Address
- 12595 S Minuteman Dr
Draper, UT 84020 - Phone
- (801) 882-2618
- Fax
- (801) 882-2618
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 104100000X
- Licence states on file
- TX, UT
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2026-06-29
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah