Healthcare Provider Details

I. General information

NPI: 1356140735
Provider Name (Legal Business Name): CRYSTAL LEE HAMBLIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

IV. Provider business mailing address

575 CLARK ST
GREEN RIVER WY
82935-5110
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-6082
  • Fax:
Mailing address:
  • Phone: 307-871-6304
  • Fax: 307-224-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number56545
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: