MEDICARE: DR. KIM KNOX FAULKNER PH.D.

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	103TC1900X	Counseling Psychologist	223	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	:	1215928965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM KNOX FAULKNER PH.D.

Provider Business Mailing Address
First Line	:	175 PINE ST
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-2332
Country	:	US
Telephone Number	:	307-684-5828
Fax Number	:	307-684-5803

Provider Business Practice Location Address
First Line	:	135 PINE STREET
Second Line	:	SUITE B
City	:	BUFFALO
State	:	WY
Zip	:	82834-2332
Country	:	US
Telephone Number	:	307-684-5828
Fax Number	:	307-684-5803

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/29/2017

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