Healthcare Provider Details

I. General information

NPI: 1184733743
Provider Name (Legal Business Name): JOLENA M MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLENA M. KING, SOSAMON P.A.-C.

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 WEST BRIDGE ST
SARATOGA WY
82331
US

IV. Provider business mailing address

PO BOX 930
SARATOGA WY
82331-0930
US

V. Phone/Fax

Practice location:
  • Phone: 307-329-3340
  • Fax: 307-225-2095
Mailing address:
  • Phone: 217-474-5658
  • Fax: 307-225-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA860
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: