Healthcare Provider Details

I. General information

NPI: 1215639968
Provider Name (Legal Business Name): KYLEE DESIREE GEYER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N MILLWARD ST
JACKSON WY
83001-8581
US

IV. Provider business mailing address

PO BOX 12774
JACKSON WY
83002-2774
US

V. Phone/Fax

Practice location:
  • Phone: 901-569-5690
  • Fax:
Mailing address:
  • Phone: 307-733-2443
  • Fax: 307-733-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number166039
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: