Provider Demographics
NPI:1629320775
Name:SUNLIGHT PSYCHIATRY
Entity Type:Organization
Organization Name:SUNLIGHT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NURSE PRA
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:307-764-4130
Mailing Address - Street 1:145 N BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2617
Mailing Address - Country:US
Mailing Address - Phone:307-764-4130
Mailing Address - Fax:
Practice Address - Street 1:145 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2617
Practice Address - Country:US
Practice Address - Phone:307-764-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19373.1191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty