Provider Demographics
NPI:1831505262
Name:ADVANCED PRACTICE, LLC
Entity type:Organization
Organization Name:ADVANCED PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FPMHNP-BC
Authorized Official - Phone:888-504-4074
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-1163
Mailing Address - Country:US
Mailing Address - Phone:888-504-4074
Mailing Address - Fax:307-462-0662
Practice Address - Street 1:733 BIG HORN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2605
Practice Address - Country:US
Practice Address - Phone:888-504-4074
Practice Address - Fax:307-462-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19926.0821363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW26805Medicare PIN