=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609565845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY DENNINGMANN PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2023
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3116 WILLETT DR
-----------------------------------------------------
City | LARAMIE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82072-5048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-755-4540
-----------------------------------------------------
Fax | 307-755-4539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3116 WILLETT DR
-----------------------------------------------------
City | LARAMIE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82072-5048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-755-4540
-----------------------------------------------------
Fax | 307-755-4539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 44417
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 44417
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------