Healthcare Provider Details

I. General information

NPI: 1609791359
Provider Name (Legal Business Name): ASHLYN SUZANNE MELLEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST STE 203
CASPER WY
82601-3251
US

IV. Provider business mailing address

2023 NOTTINGHAM DR
CASPER WY
82609-3517
US

V. Phone/Fax

Practice location:
  • Phone: 307-216-5310
  • Fax:
Mailing address:
  • Phone: 307-851-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59740
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: