Healthcare Provider Details

I. General information

NPI: 1235091539
Provider Name (Legal Business Name): GALLARDO HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 GETTYSBURG DR
CHEYENNE WY
82001-7434
US

IV. Provider business mailing address

920 GETTYSBURG DR
CHEYENNE WY
82001-7434
US

V. Phone/Fax

Practice location:
  • Phone: 307-761-4749
  • Fax:
Mailing address:
  • Phone: 307-761-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WYATT POWELL-GALLARDO
Title or Position: CASE MANAGER
Credential: RN,BSN
Phone: 307-761-4719