Healthcare Provider Details

I. General information

NPI: 1316622483
Provider Name (Legal Business Name): PRESTON RANDALL HOBBS PPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 THOMES AVE
CHEYENNE WY
82001-3029
US

IV. Provider business mailing address

2710 THOMES AVE
CHEYENNE WY
82001-3029
US

V. Phone/Fax

Practice location:
  • Phone: 307-200-7184
  • Fax:
Mailing address:
  • Phone: 307-200-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-2464
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: