Provider Demographics
NPI:1235210451
Name:KING, WENDY BURLEIGH (APRN)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:BURLEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1126
Mailing Address - Country:US
Mailing Address - Phone:307-460-9888
Mailing Address - Fax:307-460-9892
Practice Address - Street 1:100 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3239
Practice Address - Country:US
Practice Address - Phone:307-460-9888
Practice Address - Fax:307-460-9892
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY184370722363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115050200Medicaid
WY312177OtherBC/BS
WY312177OtherBC/BS
WY115050200Medicaid
WY312177OtherBC/BS