=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588571533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALT LIGHT HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2026
-----------------------------------------------------
Last Update Date | 08/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10541 MUSTANG WELLS DR
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76126-6461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-733-9080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10541 MUSTANG WELLS DR
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76126-6461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-733-9080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MATTHEW AARON WOODWORTH
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 817-733-9080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------