Individual provider Active NPI

Jessica H Gaylord, FNP

  • Family Nurse Practitioner
  • Flagstaff, AZ
National Provider Identifier
1861546384
Registry record updated Oct 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP2537 Issued in AZ
Practice address
2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone
(928) 233-5110
Fax
(928) 774-4808
NPI assigned
Jan 22, 2007
Last updated
Oct 21, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP2537 AZ Primary

Addresses

Primary practice location

2920 N 4TH St
Flagstaff, AZ 86004-1816

Mailing address

PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 213-6100

Other identifiers 1

IdentifierTypeStateIssuer
418354MedicaidAZ

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
I20090518000567 AZ Practitioner - Nurse Practitioner 3072662261

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP2537AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Healthcare, Inc. Current Accepting new patients
North Country Healthcare, Inc. CurrentSince Apr 1, 2009 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients
North Country Healthcare, Inc. CurrentSince Apr 1, 2009 Accepting new patients

Locations

1120 W University Ave
Flagstaff, AZ 86001
Phone (928) 522-1300

2187 N Vickey St
Ste 2
Flagstaff, AZ 86004
Phone (928) 527-1899

2500 N Rose St
Flagstaff, AZ 86004
Phone (928) 213-6121

2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100

2109 Navajo Blvd
Holbrook, AZ 86025
Phone (928) 213-6100

1510 N Stockton Hill Rd
Kingman, AZ 86401
Phone (928) 753-1177

2090 Smoketree Ave N
Lk Havasu Cty, AZ 86403
Phone (928) 854-1800

2650 E Show Low Lake Rd
Ste 1
Show Low, AZ 85901
Phone (928) 537-4300

488 S Mountain Ave
Springerville, AZ 85938
Phone (928) 333-0127

301 S 7th St
Williams, AZ 86046
Phone (928) 607-7227

620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382313600000",
    "number": "1861546384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630",
            "telephone_number": "928-213-6100",
            "fax_number": "928-774-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-233-5110",
            "fax_number": "928-774-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYLORD",
        "first_name": "JESSICA",
        "middle_name": "H",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2013-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP2537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "418354",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.