Healthcare Provider Details

I. General information

NPI: 1568514743
Provider Name (Legal Business Name): KRISTEN D WASHBURN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KRISTEN D BEECK

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AIRPORT PKWY SUITE 230
CHEYENNE WY
82001-1518
US

IV. Provider business mailing address

40 FORT WARREN AVE UNIT B
CHEYENNE WY
82001-8269
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0435
  • Fax: 307-432-0531
Mailing address:
  • Phone: 307-635-2617
  • Fax: 307-432-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA976
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: