MEDICARE: KERRY CARR INTEGRATIVE MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1407792211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERRY CARR INTEGRATIVE MENTAL HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 1186
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-1186
Country	:	US
Telephone Number	:	307-413-1163
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S CACHE ST
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-207-3301
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	KERRY BROOKE CARR
Credential	:	NP
Telephone Number	:	307-413-1163

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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