Healthcare Provider Details

I. General information

NPI: 1053181701
Provider Name (Legal Business Name): PURPLE SKIES HEALTH AND VITALITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W FETTERMAN ST UNIT 1
BUFFALO WY
82834-2449
US

IV. Provider business mailing address

PO BOX 975
BUFFALO WY
82834-0975
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-8136
  • Fax: 307-785-1096
Mailing address:
  • Phone: 307-221-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RASMUSON
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP-C
Phone: 307-221-6430