MEDICARE: ALIX VATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	56295	WY

General Provider Information

NPI Number	:	1780535237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIX VATH

Provider Business Mailing Address
First Line	:	PO BOX 11603
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-1603
Country	:	US
Telephone Number	:	985-630-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 SCOTT LN STE 105
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8060
Country	:	US
Telephone Number	:	985-630-9499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ ALIX VATH ” Practice Location

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