Healthcare Provider Details

I. General information

NPI: 1780936419
Provider Name (Legal Business Name): JENNIFER R TRYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER R PAXTON

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 BLACKBURN ST
CODY WY
82414-8014
US

IV. Provider business mailing address

902 BLACKBURN ST
CODY WY
82414-8014
US

V. Phone/Fax

Practice location:
  • Phone: 307-291-0447
  • Fax:
Mailing address:
  • Phone: 307-291-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1217
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: