Healthcare Provider Details

I. General information

NPI: 1043843485
Provider Name (Legal Business Name): JESSICA LEE MATHEWS COMMUNITY PARAMEDIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 AVENUE H
POWELL WY
82435-2260
US

IV. Provider business mailing address

1244 ROAD 9
POWELL WY
82435-8620
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-1175
  • Fax: 307-754-1191
Mailing address:
  • Phone: 307-578-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number47302
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: