Provider Demographics
NPI:1215247440
Name:WOODY, AMY COLVIN (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:COLVIN
Last Name:WOODY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 S BERGEN CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6800
Mailing Address - Country:US
Mailing Address - Phone:801-710-2402
Mailing Address - Fax:
Practice Address - Street 1:54 N 8TH W
Practice Address - Street 2:NORTH TEMPLE CLINIC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3326
Practice Address - Country:US
Practice Address - Phone:801-406-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5946672-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily