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General NPI Number Information
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NPI Number | 1023177375
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Entity Type | Organization
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Legal Business Name | UINTA URGENT CARE
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 75 YELLOW CREEK RD SUITE 202
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City | EVANSTON
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State | WY
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Zip | 82930
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Country | US
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Telephone | 307-789-6111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1382
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City | EVANSTON
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State | WY
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Zip | 82931-1382
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Country | US
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Telephone | 307-789-6111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KIMBERLY ANNE BEGALLA
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Credential | CFNP
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Telephone | 307-789-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19196.0204
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License Number State | WY
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