Healthcare Provider Details

I. General information

NPI: 1104418789
Provider Name (Legal Business Name): KATHLEEN PARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E 20TH ST STE 300
CHEYENNE WY
82001-3783
US

IV. Provider business mailing address

3415 CHEYENNE ST STE A
CHEYENNE WY
82001-1774
US

V. Phone/Fax

Practice location:
  • Phone: 307-701-5400
  • Fax: 307-514-3337
Mailing address:
  • Phone: 307-638-2505
  • Fax: 307-634-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number47162
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: