Healthcare Provider Details

I. General information

NPI: 1104459338
Provider Name (Legal Business Name): JANELLE KAY HOAGLUND FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 20TH ST STE 300
CHEYENNE WY
82001-3882
US

IV. Provider business mailing address

800 E 20TH ST STE 300
CHEYENNE WY
82001-3882
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7444
  • Fax:
Mailing address:
  • Phone: 307-633-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number995372
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: