MEDICARE: KIMBERLY ANNE BEGALLA CFNP

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	363L00000X	Nurse Practitioner	19196.0204	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174563241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE BEGALLA CFNP

Provider Business Mailing Address
First Line	:	PO BOX 1382
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82931-1382
Country	:	US
Telephone Number	:	307-789-6111
Fax Number	:	307-789-7111

Provider Business Practice Location Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	SUITE 202
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-6111
Fax Number	:	307-789-7111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/14/2015

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