Provider Demographics
NPI:1346470770
Name:LE PARD, ALICIA MAE (APRN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MAE
Last Name:LE PARD
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 1:405 W BOXELDER RD
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5320
Mailing Address - Country:US
Mailing Address - Phone:307-257-7620
Mailing Address - Fax:307-257-7618
Practice Address - Street 1:405 W BOXELDER RD
Practice Address - Street 2:SUITE B-8
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5320
Practice Address - Country:US
Practice Address - Phone:307-257-7620
Practice Address - Fax:307-257-7618
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17516-1002163WD0400X, 163WE0003X, 363LA2100X
WY17516.1002363L00000X, 363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology