Healthcare Provider Details

I. General information

NPI: 1578356366
Provider Name (Legal Business Name): BRIANNA LEIGH MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GRINNELL PLZ
SHERIDAN WY
82801-3931
US

IV. Provider business mailing address

30 GRINNELL PLZ
SHERIDAN WY
82801-3931
US

V. Phone/Fax

Practice location:
  • Phone: 307-217-2161
  • Fax:
Mailing address:
  • Phone: 307-217-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number101YM0800X
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: