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General NPI Number Information
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NPI Number | 1437556453
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Entity Type | Individual
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Provider Name | KELLY JO PLESSMAN FNP, AANPC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1909 VISTA DR BLDG C
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City | LARAMIE
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State | WY
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Zip | 82070-5530
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Country | US
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Telephone | 307-212-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 5131 E 17TH ST
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City | CASPER
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State | WY
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Zip | 82609-3763
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Country | US
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Telephone | 307-472-0392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14966.1365
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License Number State | WY
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