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General NPI Number Information
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NPI Number | 1306769096
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Entity Type | Organization
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Legal Business Name | WYOMING CLINIC OF MEDICINE, LLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 528 COFFEEN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-5312
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Country | US
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Telephone | 307-683-7138
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Fax | 307-655-8770
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Provider Business Mailing Address
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Address Line | 1485 OXBOW DR
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City | SHERIDAN
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State | WY
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Zip | 82801-9622
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Country | US
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Telephone | 307-683-7138
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Fax | 307-655-8770
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Authorized Official
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Title or Position | OWNER
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Name | GORDON HENDRICKSON
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Credential | PA-C
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Telephone | 307-683-7138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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