Provider Demographics
NPI:1891675021
Name:CANYON CREEK HEALTH AND WELLNESS
Entity type:Organization
Organization Name:CANYON CREEK HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENTRY
Authorized Official - Middle Name:CORA
Authorized Official - Last Name:MCKELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-310-5878
Mailing Address - Street 1:245 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1957
Mailing Address - Country:US
Mailing Address - Phone:385-543-5266
Mailing Address - Fax:385-503-2493
Practice Address - Street 1:245 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1957
Practice Address - Country:US
Practice Address - Phone:385-543-5266
Practice Address - Fax:385-503-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty