Provider Demographics
NPI:1235855792
Name:BARNUM, LEVI (PA-C)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:BARNUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:LEVI
Other - Middle Name:DOUGLAS OTIS
Other - Last Name:BARNUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1140 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3211
Mailing Address - Country:US
Mailing Address - Phone:239-560-0081
Mailing Address - Fax:
Practice Address - Street 1:1522 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2254
Practice Address - Country:US
Practice Address - Phone:307-234-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA1037207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine