Provider Demographics
NPI:1942972187
Name:YEGO, BERNARD KIPTOLO
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:KIPTOLO
Last Name:YEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 DANNI MARIE CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3845
Mailing Address - Country:US
Mailing Address - Phone:307-575-6473
Mailing Address - Fax:
Practice Address - Street 1:7500 DANNI MARIE CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3845
Practice Address - Country:US
Practice Address - Phone:307-575-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY48418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner