Provider Demographics
NPI:1457990533
Name:THORMAHLEN, KYLEE ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KYLEE
Middle Name:ANN
Last Name:THORMAHLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:COWLEY
Mailing Address - State:WY
Mailing Address - Zip Code:82420-0716
Mailing Address - Country:US
Mailing Address - Phone:307-221-5268
Mailing Address - Fax:
Practice Address - Street 1:31 W 3RD ST S
Practice Address - Street 2:
Practice Address - City:COWLEY
Practice Address - State:WY
Practice Address - Zip Code:82420-5056
Practice Address - Country:US
Practice Address - Phone:307-221-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WY23803163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY23803OtherRN LICENSE