=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730076191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEIRA LYNN SANDERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 E KENDRICK ST
-----------------------------------------------------
City | RAWLINS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82301-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-321-4900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 E KENDRICK ST
-----------------------------------------------------
City | RAWLINS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82301-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-321-4900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------