Provider Demographics
NPI:1083310882
Name:GAMUT HEALTH PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:GAMUT HEALTH PROFESSIONAL ASSOCIATION
Other - Org Name:GAMUT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:574-360-2120
Mailing Address - Street 1:2760 W PEORIA AVE # 1184
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5202
Mailing Address - Country:US
Mailing Address - Phone:602-833-2273
Mailing Address - Fax:
Practice Address - Street 1:9700 N 91ST ST STE A115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5036
Practice Address - Country:US
Practice Address - Phone:602-833-2273
Practice Address - Fax:602-883-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty