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General NPI Number Information
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NPI Number | 1629320775
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Entity Type | Organization
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Legal Business Name | SUNLIGHT PSYCHIATRY
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 145 N BERNARD ST
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City | POWELL
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State | WY
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Zip | 82435-2617
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Country | US
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Telephone | 307-764-4130
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Fax |
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Provider Business Mailing Address
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Address Line | 145 N BERNARD ST
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City | POWELL
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State | WY
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Zip | 82435-2617
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Country | US
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Telephone | 307-764-4130
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NURSE PRA
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Name | KRISTA L BLOUGH
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Credential | APRN
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Telephone | 307-764-4130
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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 | 19373.1191
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License Number State | WY
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