Healthcare Provider Details

I. General information

NPI: 1225409477
Provider Name (Legal Business Name): KERI LYNN HULL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERI KOGER

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E HENNICK ST
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 627
PINEDALE WY
82941
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-4132
  • Fax: 307-367-6636
Mailing address:
  • Phone: 307-367-4133
  • Fax: 307-367-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36333.1435
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: