Healthcare Provider Details

I. General information

NPI: 1861317653
Provider Name (Legal Business Name): KAITLYNN FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYNN SHARP

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N ST STE 201
ROCK SPRINGS WY
82901-5474
US

IV. Provider business mailing address

615 SUNDANCE DR
GREEN RIVER WY
82935-5552
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-3466
  • Fax:
Mailing address:
  • Phone: 307-871-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-1625
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: