Healthcare Provider Details

I. General information

NPI: 1184587925
Provider Name (Legal Business Name): ALYSSA JO WHITLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

424 YELLOWSTONE AVE STE 330
CODY WY
82414-8917
US

IV. Provider business mailing address

707 SHERIDAN AVE
CODY WY
82414-3409
US

V. Phone/Fax

Practice location:
  • Phone: 307-578-2770
  • Fax:
Mailing address:
  • Phone: 307-527-7501
  • Fax: 307-578-2485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number43660
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number43660
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number43660
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: