Provider Demographics
NPI:1235286634
Name:CHEYENNE-LARAMIE COUNTY FAMILY PLANNING
Entity Type:Organization
Organization Name:CHEYENNE-LARAMIE COUNTY FAMILY PLANNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-633-4054
Mailing Address - Street 1:100 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1330
Mailing Address - Country:US
Mailing Address - Phone:307-633-4040
Mailing Address - Fax:307-633-4050
Practice Address - Street 1:100 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1330
Practice Address - Country:US
Practice Address - Phone:307-633-4040
Practice Address - Fax:307-633-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY836000111251K00000X
261QA0005X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning FacilityGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114131Medicaid