Healthcare Provider Details

I. General information

NPI: 1407792211
Provider Name (Legal Business Name): KERRY CARR INTEGRATIVE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S CACHE ST
JACKSON WY
83001-8222
US

IV. Provider business mailing address

PO BOX 1186
JACKSON WY
83001-1186
US

V. Phone/Fax

Practice location:
  • Phone: 307-207-3301
  • Fax:
Mailing address:
  • Phone: 307-413-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KERRY BROOKE CARR
Title or Position: OWNER/PROVIDER
Credential: NP
Phone: 307-413-1163