Healthcare Provider Details

I. General information

NPI: 1831966266
Provider Name (Legal Business Name): COMMUNITY STRONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PINE AVE STE 3B
KEMMERER WY
83101-3237
US

IV. Provider business mailing address

1208 HILLTOP DR STE 204
ROCK SPRINGS WY
82901-5859
US

V. Phone/Fax

Practice location:
  • Phone: 405-229-7898
  • Fax:
Mailing address:
  • Phone: 405-229-7898
  • Fax: 877-552-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY D WALSH
Title or Position: CAO
Credential:
Phone: 405-229-7898