Healthcare Provider Details

I. General information

NPI: 1669398731
Provider Name (Legal Business Name): KATHLEEN ANNE WARNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SHADOW ST
CODY WY
82414-5455
US

IV. Provider business mailing address

807 SHADOW ST
CODY WY
82414-5455
US

V. Phone/Fax

Practice location:
  • Phone: 406-696-7164
  • Fax:
Mailing address:
  • Phone: 406-696-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53245
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: