Provider Demographics
NPI:1356964464
Name:GEBAUER, KELLY (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GEBAUER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E CARLSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4335
Mailing Address - Country:US
Mailing Address - Phone:307-364-3415
Mailing Address - Fax:307-296-0349
Practice Address - Street 1:611 E CARLSON ST STE 102
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4335
Practice Address - Country:US
Practice Address - Phone:307-364-3415
Practice Address - Fax:307-296-0349
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22963163WW0101X
WY47173363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner