Provider Demographics
NPI:1487831129
Name:SALTER, JOEL JAYSON (DC, FNP-C, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JAYSON
Last Name:SALTER
Suffix:
Gender:M
Credentials:DC, FNP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 E BASELINE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2731
Mailing Address - Country:US
Mailing Address - Phone:480-508-1522
Mailing Address - Fax:480-576-7469
Practice Address - Street 1:3921 E BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2731
Practice Address - Country:US
Practice Address - Phone:480-508-1522
Practice Address - Fax:480-576-7469
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5190363LP0808X, 363LF0000X
UT6858781-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ896977Medicaid
AZZ167489Medicare PIN