Provider Demographics
NPI:1104868017
Name:MYERS, VIRGINIA L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E A ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2260
Mailing Address - Country:US
Mailing Address - Phone:307-237-1900
Mailing Address - Fax:307-268-8514
Practice Address - Street 1:1300 E A ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2260
Practice Address - Country:US
Practice Address - Phone:307-237-1900
Practice Address - Fax:307-268-8514
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY331363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1206257Medicaid
WYS53075Medicare UPIN
WY1206257Medicaid