MEDICARE: BE WELL WYOMING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1104600741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE WELL WYOMING, LLC

Provider Business Mailing Address
First Line	:	150 E B ST # 392
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-7004
Country	:	US
Telephone Number	:	307-243-8181
Fax Number	:	765-238-4859

Provider Business Practice Location Address
First Line	:	1771 GOODSTEIN DR STE B
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-6222
Country	:	US
Telephone Number	:	307-243-8181
Fax Number	:	765-238-4859

Authorized Official
Title or Position	:	OWNER
Name	:	ANNA LEIGH OHEARN
Credential	:	NP
Telephone Number	:	562-595-2754

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	03/11/2026

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