Healthcare Provider Details

I. General information

NPI: 1215782230
Provider Name (Legal Business Name): BRANDON JAGGI PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 CENTER ST STE 1
EVANSTON WY
82930-3400
US

IV. Provider business mailing address

913 CENTER ST STE 1
EVANSTON WY
82930-3400
US

V. Phone/Fax

Practice location:
  • Phone: 307-300-5885
  • Fax:
Mailing address:
  • Phone: 307-300-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number115908
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number52431
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: