| NPI | 1679115919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SHEDD CEO 307-271-2332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2022-10-20 |