Healthcare Provider Details

I. General information

NPI: 1427545938
Provider Name (Legal Business Name): FIVE SPRINGS HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 N ABSAROKA ST
POWELL WY
82435-2331
US

IV. Provider business mailing address

246 N ABSAROKA ST
POWELL WY
82435-2331
US

V. Phone/Fax

Practice location:
  • Phone: 307-272-4284
  • Fax:
Mailing address:
  • Phone: 307-764-5470
  • Fax: 307-764-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELBY MARIE FROST
Title or Position: OWNER
Credential: APRN
Phone: 307-764-5470