Healthcare Provider Details

I. General information

NPI: 1174407621
Provider Name (Legal Business Name): O'BRIEN EILEEN MELLARS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

IV. Provider business mailing address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-1311
  • Fax: 307-432-7546
Mailing address:
  • Phone: 307-634-1311
  • Fax: 307-432-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number50954
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: