Individual provider Active NPI

Utibe Joshua Etudor, NP

  • Gerontology Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1538725916
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
234106 Issued in AZ
Practice address
802 Ainsworth Dr Ste a
Prescott, AZ 86301-1623
Phone
(928) 771-5548
Fax
(928) 771-5549
NPI assigned
May 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 234106 AZ Primary

Addresses

Primary practice location

802 Ainsworth Dr Ste a
Prescott, AZ 86301-1623

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20200127002448 AZ Practitioner - Nurse Practitioner 8527493287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

810 Ainsworth Dr
Suite a
Prescott, AZ 86301-1612
Phone (928) 771-5548

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Feb 10, 2020 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Feb 10, 2020 Accepting new patients
Prescott Gastroenterology Past Accepting new patients

Locations

810 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 771-5548

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

802 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 445-6025

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": "1557532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1538725916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 AINSWORTH DR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011623",
            "telephone_number": "928-771-5548",
            "fax_number": "928-771-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETUDOR",
        "first_name": "UTIBE",
        "middle_name": "JOSHUA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-11",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "234106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.