Healthcare Provider Details

I. General information

NPI: 1053264598
Provider Name (Legal Business Name): HIGH DESERT WOUND SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FEATHER WAY
EVANSTON WY
82930-9352
US

IV. Provider business mailing address

195 FEATHER WAY
EVANSTON WY
82930-9352
US

V. Phone/Fax

Practice location:
  • Phone: 307-679-4959
  • Fax: 307-679-4959
Mailing address:
  • Phone: 307-679-4959
  • Fax: 307-679-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRADY STOKES
Title or Position: MEMBER
Credential: PT
Phone: 307-679-4959