Healthcare Provider Details

I. General information

NPI: 1013832542
Provider Name (Legal Business Name): MOLLY KATHERINE EAGAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E PEARL AVE
JACKSON WY
83001-8410
US

IV. Provider business mailing address

PO BOX 12784
JACKSON WY
83002-2784
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-6401
  • Fax:
Mailing address:
  • Phone: 978-587-6577
  • Fax: 307-732-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN53633
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: