Healthcare Provider Details

I. General information

NPI: 1023948254
Provider Name (Legal Business Name): AYSHA NICOLE SPIKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S BEVERLY ST APT 307
CASPER WY
82609-2802
US

IV. Provider business mailing address

1100 S BEVERLY ST APT 307
CASPER WY
82609-2802
US

V. Phone/Fax

Practice location:
  • Phone: 307-394-1825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: