=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063962140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY WEBB APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 N FREEDOM BLVD
-----------------------------------------------------
City | PROVO
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84601-1677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-373-4760
-----------------------------------------------------
Fax | 801-373-0639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10068 N 5800 W
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-9115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-225-4258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 128181
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 8501433-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 8501433-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------