Provider Demographics
NPI:1942395686
Name:ENGELKING, KERRY G (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:G
Last Name:ENGELKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 2ND ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2454
Mailing Address - Country:US
Mailing Address - Phone:307-237-5848
Mailing Address - Fax:307-237-5848
Practice Address - Street 1:10240 W POISON SPIDER RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-9556
Practice Address - Country:US
Practice Address - Phone:307-277-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3569A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307121OtherBLUE SHIELD
WY104206801OtherWYOMING MEDICAID
WY050037998OtherRAILROAD MEDICARE
WY104206800Medicaid