Provider Demographics
NPI:1780936419
Name:TRYDER, JENNIFER R (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:TRYDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 W MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2718
Mailing Address - Country:US
Mailing Address - Phone:406-535-6545
Mailing Address - Fax:
Practice Address - Street 1:902 BLACKBURN ST STE F
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8015
Practice Address - Country:US
Practice Address - Phone:307-291-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23690.1217363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program