Healthcare Provider Details

I. General information

NPI: 1467100461
Provider Name (Legal Business Name): JODY M NEWMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 E 550 S
PAYSON UT
84651-8557
US

IV. Provider business mailing address

1339 E 550 S
PAYSON UT
84651-8557
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-1763
  • Fax:
Mailing address:
  • Phone: 801-367-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9426842-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: