Marybeth Wilson, F.N.P

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

6191957-4405 Issued in UT

Practice address

550 E 1400 N
Suite I
Logan, UT 84341-2406

Phone

(435) 753-1545

NPI assigned

Jan 12, 2012

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

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Canyon Medical Group LLCGroup PAC ID 9032002373, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Canyon Medical Group LLC

  • Pediatrics Physician
  • Logan, UT
  • NPI 1952599409

  UT

  Medicare reassignment Care Compare group NPD
• Jon W Ahlstrom MD PC

  • Obstetrics & Gynecology Physician
  • North Logan, UT
  • NPI 1679847784
  NPD (past)

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

• Ihc Health Services Inc

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1487925012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 E 1400 N",
            "address_2": "SUITE I",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412406",
            "telephone_number": "435-753-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E 1400 N",
            "address_2": "SUITE I",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412406",
            "telephone_number": "435-753-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARYBETH",
        "credential": "F.N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "6191957-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willis Orthodontics
• Craig Willis, DDS
• James Willmore, RPH.
• Myrle Willmore, RPH
• Willow Haven Counseling LLC
• Matthew Allen Wilson, M.D.
• Erin L Wimmer
• Tanner Winger
• Tiffany Wink, PT, DPT
• Kevin Clare Winn

• All providers in Logan, UT
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.