Basic Information
| Provider Information | |||||||||
| NPI: | 1801553060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODBURY | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753500 | ||||||||
| FaxNumber: | 8014753494 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 S 3000 W | ||||||||
| Address2: | |||||||||
| City: | WEST POINT | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840157414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753960 | ||||||||
| FaxNumber: | 8014753961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 9259962-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.