Healthcare Provider Details

I. General information

NPI: 1245190636
Provider Name (Legal Business Name): CHENGJUI KOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DELL RANGE BLVD
CHEYENNE WY
82009-5273
US

IV. Provider business mailing address

750 W 2ND ST APT D
CHEYENNE WY
82007-1768
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-4729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number57642
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: