Healthcare Provider Details

I. General information

NPI: 1205342029
Provider Name (Legal Business Name): KATHRYN LEE CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN BRYANT

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SHERIDAN AVE
CODY WY
82414-3409
US

IV. Provider business mailing address

1331 ARIZONA PL
CODY WY
82414-4722
US

V. Phone/Fax

Practice location:
  • Phone: 307-527-7501
  • Fax: 307-578-2485
Mailing address:
  • Phone: 307-527-7501
  • Fax: 307-578-2485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number71007691A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number57075
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number57075
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71007691A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: