Healthcare Provider Details

I. General information

NPI: 1942193107
Provider Name (Legal Business Name): SAGE AND STONE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 SKYLINE DR
BONDURANT WY
82922
US

IV. Provider business mailing address

680 S CACHE ST STE 100-6949
JACKSON WY
83001-8694
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-1825
  • Fax:
Mailing address:
  • Phone: 307-352-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE L TRAYLOR
Title or Position: OWNER
Credential: FNP
Phone: 307-389-8387