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General NPI Number Information
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NPI Number | 1124188545
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Entity Type | Organization
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Legal Business Name | ANTELOPE MEDICAL CONSULTANTS LLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 430 S MEDICAL ARTS CT
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City | GILLETTE
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State | WY
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Zip | 82716-3364
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Country | US
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Telephone | 307-682-7661
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Fax | 307-682-5074
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Provider Business Mailing Address
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Address Line | 430 S MEDICAL ARTS CT
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City | GILLETTE
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State | WY
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Zip | 82716-3364
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Country | US
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Telephone | 307-682-7661
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Fax | 307-682-5074
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA ANNE MALODY
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Credential | M.D.
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Telephone | 307-682-7661
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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 | 18882.269
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5806A
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5853A
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License Number State | WY
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