Healthcare Provider Details

I. General information

NPI: 1114402849
Provider Name (Legal Business Name): JAMIE CATHERINE KIDDER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 E 2ND ST
CASPER WY
82609-4338
US

IV. Provider business mailing address

6350 E 2ND ST
CASPER WY
82609-4264
US

V. Phone/Fax

Practice location:
  • Phone: 307-995-8100
  • Fax:
Mailing address:
  • Phone: 307-258-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19956.1807
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: