Healthcare Provider Details

I. General information

NPI: 1679373930
Provider Name (Legal Business Name): GABRIELLE LEE TRAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S CACHE ST STE 100-6949
JACKSON WY
83001-8694
US

IV. Provider business mailing address

680 S CACHE ST STE 100-6949
JACKSON WY
83001-8694
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-1825
  • Fax:
Mailing address:
  • Phone: 760-696-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP003312
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP897870
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCAPN0106394CNP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-CNP1197502
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56351
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNURAPRNLIC286824
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14260145-4405
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRNCNP204419
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: