Healthcare Provider Details

I. General information

NPI: 1881511566
Provider Name (Legal Business Name): CALLIE ROSE JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S DIVISION ST
POWELL WY
82435-2409
US

IV. Provider business mailing address

PO BOX 847
POWELL WY
82435-0847
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-7970
  • Fax: 307-333-0470
Mailing address:
  • Phone: 307-754-7970
  • Fax: 307-333-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number216
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: