Healthcare Provider Details

I. General information

NPI: 1114889631
Provider Name (Legal Business Name): GAYLE JUMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 N VENTURE DR STE B-105
ANTHEM AZ
85086-3823
US

IV. Provider business mailing address

6634 E HORSESHOE RD
PARADISE VALLEY AZ
85253-2305
US

V. Phone/Fax

Practice location:
  • Phone: 480-235-1682
  • Fax:
Mailing address:
  • Phone: 717-491-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-23672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: