Individual provider Active NPI

Gary Webb, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Provo, UT
National Provider Identifier
1063962140
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
8501433-4405 Issued in UT
Practice address
750 N Freedom Blvd
Provo, UT 84601-1677
Phone
(801) 373-4760
Fax
(801) 373-0639
NPI assigned
Oct 12, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 8501433-4405 UT Primary
Student in an Organized Health Care Education/Training Program 390200000X NU
Psychiatric/Mental Health Registered Nurse 163WP0808X 128181 CT
Psychiatric/Mental Health Registered Nurse 163WP0808X 8501433-3102 UT

Addresses

Primary practice location

750 N Freedom Blvd
Provo, UT 84601-1677

Mailing address

10068 N 5800 W
Highland, UT 84003-9115
Phone (435) 225-4258

Other practice location 1

45 Wadsworth St
Hartford, CT 06106-7108
Phone (860) 527-1124 ext. 257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170822000592 UT Practitioner - Nurse Practitioner 7214209501 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Numinus Wellness Ut IncGroup PAC ID 2163750688, 50 clinicians

Practice addresses (Care Compare)

672 W 400
Suite 201
Springville, UT 84663-3170
Phone (801) 369-8989

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
128181CTMDPsychiatric/Mental Health Registered Nurse
8501433-4405UTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Numinus Wellness Ut Inc CurrentSince Jun 1, 2022 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince Aug 1, 2017 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince Aug 1, 2017 Accepting new patients

Locations

1165 E 300 N
Provo, UT 84606
Phone (801) 319-1142

750 N Freedom Blvd
Provo, UT 84601
Phone (801) 373-0639

750 N Freedom Blvd
Ste 300
Provo, UT 84601
Phone (801) 372-4760

672 W 400 S
Ste 201
Springville, UT 84663
Phone (435) 621-5224

Interoperability endpoints

  • Direct secure messaging: gary.webb.1@17324.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1063962140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10068 N 5800 W",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840039115",
            "telephone_number": "435-225-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011677",
            "telephone_number": "801-373-4760",
            "fax_number": "801-373-0639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Wadsworth St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061067108",
            "country_code": "US",
            "telephone_number": "860-527-1124 x257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEBB",
        "first_name": "GARY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "8501433-4405",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CT",
            "license": "128181",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "UT",
            "license": "8501433-3102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.