Healthcare Provider Details

I. General information

NPI: 1235231028
Provider Name (Legal Business Name): CHEYENNE KIDNEY AND DIALYSIS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE SUITE 201
CHEYENNE WY
82001-3177
US

IV. Provider business mailing address

2301 HOUSE AVE SUITE 201
CHEYENNE WY
82001-3177
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-9131
  • Fax: 307-637-8300
Mailing address:
  • Phone: 307-635-9131
  • Fax: 307-637-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN A HALPERN
Title or Position: CEO
Credential: MD
Phone: 307-635-9131