Healthcare Provider Details

I. General information

NPI: 1336215441
Provider Name (Legal Business Name): LARAMIE PEDIATRICS INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 NORTH 22ND ST STE B
LARAMIE WY
82072
US

IV. Provider business mailing address

1252 NORTH 22ND ST STE B
LARAMIE WY
82072
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-3704
  • Fax: 307-745-7237
Mailing address:
  • Phone: 307-745-3704
  • Fax: 307-745-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENT MYRON KLEPPINGER
Title or Position: MD
Credential: MD
Phone: 307-745-3704