Healthcare Provider Details

I. General information

NPI: 1457064917
Provider Name (Legal Business Name): MS HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 VENTURE WAY STE 206
CASPER WY
82609-4353
US

IV. Provider business mailing address

1300 VENTURE WAY STE 206
CASPER WY
82609-4353
US

V. Phone/Fax

Practice location:
  • Phone: 307-268-9904
  • Fax: 307-298-6294
Mailing address:
  • Phone: 307-268-9904
  • Fax: 307-298-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATE WHITAKER
Title or Position: SUPERVISING PROVIDER
Credential: APRN-BC
Phone: 307-268-9904