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General NPI Number Information
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NPI Number | 1528558004
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Entity Type | Organization
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Legal Business Name | OPEN RANGE TELEPSYCHIATRY LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 30 N GOULD ST STE 7141
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City | SHERIDAN
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State | WY
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Zip | 82801-6362
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Country | US
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Telephone | 307-278-7542
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE 7141
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City | SHERIDAN
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State | WY
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Zip | 82801-6362
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Country | US
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Telephone | 307-278-7542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONDA BRAY
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Credential | PMHNP
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Telephone | 812-384-5237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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