Teton Pediatrics PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

TETON PEDIATRICS PC

Doing business as

Teton Pediatrics

Practice address

555 E Broadway Ave Ste 202
Jackson, WY 83001-8640

Phone

(307) 733-6520

Fax

(307) 733-3216

NPI assigned

Nov 18, 2020

Last updated

Dec 1, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jacquelin Foss Hardenbrook, MDNPI 1669891099

Title

Owner

Phone

(307) 733-6520

Specialties & licenses 1

Addresses

Other names 1

• Teton Pediatrics Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacquelin Foss Hardenbrook, M.D.

  • Pediatrics Physician
  • Jackson, WY
  • NPI 1669891099
  Authorized official Same address or phone

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1790388213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4182",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830014182",
            "telephone_number": "307-733-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE STE 202",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-6520",
            "fax_number": "307-733-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "HARDENBROOK",
        "authorized_official_first_name": "JACQUELIN",
        "authorized_official_middle_name": "FOSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-733-6520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teton Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teton MRI (MRI of Jackson Hole)
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• Teton Outpatient Services LLC
• Teton Pathology, PC
• Teton Psychology Clinic, LLC
• Teton Sports & Spine Imaging, LLC
• Teton Surgical Assist Services LLC
• Teton Wellness Affiliates
• Teton Youth and Family Services (Van Vleck House)

• Pediatrics Physician in Jackson, WY
• Providers in Jackson, WY by specialty
• Pediatrics Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.