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General NPI Number Information
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NPI Number | 1093002412
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST HEALTH PC
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 555 E BROADWAY AVE STE 218
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City | JACKSON
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State | WY
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Zip | 83001-8640
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Country | US
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Telephone | 307-201-1696
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12568
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City | JACKSON
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State | WY
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Zip | 83002-2568
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Country | US
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Telephone | 307-201-1696
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA J MASON
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Credential |
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Telephone | 307-201-1696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 263300970
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License Number State | WY
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