Crissi Leiann Willardson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4496 Issued in AZ

Practice address

3895 W 7800 S Ste 100
West Jordan, UT 84088-5616

Phone

(801) 309-6048

Fax

(801) 748-2790

NPI assigned

Sep 29, 2009

Last updated

Nov 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Crissi Leiann Magleby Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Jordan Landing Family Medicine LLC

  dba Jordan Landing Clinic LLC

  • Family Medicine Physician
  • West Jordan, UT
  • NPI 1962606657
  Medicare reassignment
• Onsite Care Inc

  dba Onsite Care

  • Internal Medicine Physician
  • South Jordan, UT
  • NPI 1518250109
  NPD (past)

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574899200000",
    "number": "1356675912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3895 W 7800 S STE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885616",
            "telephone_number": "801-309-6048",
            "fax_number": "801-748-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3895 W 7800 S STE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885616",
            "telephone_number": "801-309-6048",
            "fax_number": "801-748-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARDSON",
        "first_name": "CRISSI",
        "middle_name": "LEIANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-29",
        "last_updated": "2019-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRISSI",
            "last_name": "MAGLEBY",
            "middle_name": "LEIANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trinity Widner
• Ryleigh Wiechman
• Lauren Wilde
• Nathan Wiley, DNP, APRN, FNP-C
• Matthew Wilkinson, MPT
• Peter Willeitner
• William H. Webb D.D.S., P.C.
• Joseph William
• Amanda Williams
• Lilly Williams

• Physician Assistant in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.