Healthcare Provider Details

I. General information

NPI: 1023842416
Provider Name (Legal Business Name): KRISTIN A DAFOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7528 FRANKIE DR
CHEYENNE WY
82009-1166
US

IV. Provider business mailing address

7528 FRANKIE DR
CHEYENNE WY
82009-1166
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7550
  • Fax:
Mailing address:
  • Phone: 307-778-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number18887
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: