Healthcare Provider Details

I. General information

NPI: 1447168992
Provider Name (Legal Business Name): KRISTI KAY SIRES-CANNON FNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 ECHETA RD LOT 79
GILLETTE WY
82716-3122
US

IV. Provider business mailing address

3201 ECHETA RD LOT 79
GILLETTE WY
82716-3122
US

V. Phone/Fax

Practice location:
  • Phone: 605-517-2373
  • Fax:
Mailing address:
  • Phone: 605-517-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59897
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: