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General NPI Number Information
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NPI Number | 1598629024
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Entity Type | Individual
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Provider Name | TANYON KELLER
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Gender | Male
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1842 SUGARLAND DR STE 101 101
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City | SHERIDAN
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State | WY
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Zip | 82801-5719
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Country | US
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Telephone | 307-763-8701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5087
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City | SHERIDAN
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State | WY
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Zip | 82801-1387
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Country | US
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Telephone | 307-763-8701
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 52256
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License Number State | WY
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