Individual provider Active NPI

Debra J Wing, APRN

  • Acute Care Nurse Practitioner
  • Bountiful, UT
National Provider Identifier
1134228166
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4930416-4405 Issued in UT
Practice address
557 W 2600 S
Bountiful, UT 84010-7717
Phone
(801) 298-9155
Fax
(801) 298-9156
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Management Registered Nurse 163WP0000X 4930416-4405 UT
Family Nurse Practitioner 363LF0000X 4930416-4405 UT
Family Nurse Practitioner 363LF0000X 184272-0 MN
Acute Care Nurse Practitioner 363LA2100X 4930416-4405 UT Primary

Addresses

Primary practice location

557 W 2600 S
Bountiful, UT 84010-7717

Mailing address

557 W 2600 S
Bountiful, UT 84010-7717
Phone (801) 298-9155

Other names 1

  • Ms. Debra Jordan Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dwing3504@direct.med.utah.edu Direct UNIVERSITY OF UTAH

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
I20061205000269 UT Practitioner - Nurse Practitioner 4183623994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

1950 Circle of Hope Dr
Salt Lake City, UT 84112-5500
Phone (801) 581-8793

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4930416-4405UTMDPain Management Registered Nurse
184272-0MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Sep 2, 2020 Accepting new patients
University of Utah Adult Services CurrentSince Sep 2, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients

Locations

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1134228166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 W 2600 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107717",
            "telephone_number": "801-298-9155",
            "fax_number": "801-298-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 W 2600 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107717",
            "telephone_number": "801-298-9155",
            "fax_number": "801-298-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WING",
        "first_name": "DEBRA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "UT",
            "license": "4930416-4405",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "4930416-4405",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "184272-0",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "UT",
            "license": "4930416-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwing3504@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "JORDAN",
            "prefix": "MS.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.