Provider Demographics
NPI:1255727731
Name:LLOYD, JACQUELINE STUART
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:STUART
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 2855
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3323
Mailing Address - Country:US
Mailing Address - Phone:801-387-7150
Mailing Address - Fax:801-387-7155
Practice Address - Street 1:4403 HARRISON BLVD STE 2855
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3323
Practice Address - Country:US
Practice Address - Phone:801-387-7150
Practice Address - Fax:801-387-7155
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
UTUT10846260-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant