Healthcare Provider Details

I. General information

NPI: 1073431730
Provider Name (Legal Business Name): KATIE ELIZABETH KUNKLE I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 1/2 ANGLE ST
ROCK SPRINGS WY
82901-6502
US

IV. Provider business mailing address

314 1/2 ANGLE ST
ROCK SPRINGS WY
82901-6502
US

V. Phone/Fax

Practice location:
  • Phone: 817-789-2317
  • Fax:
Mailing address:
  • Phone: 817-789-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: