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NPI Code Detail

MEDICARE: KELLIE DALE CLAUSEN F.N.P.

MEDICARE: KELLIE DALE CLAUSEN F.N.P.
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
1363LF0000XFamily Nurse Practitioner14471-0152WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2313807OTHERWYBLUECROSS AND BLUESHIELD

General Provider Information

NPI Number : 1487616553
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE DALE CLAUSEN F.N.P.
Provider Business Mailing Address
First Line : 111 S 5TH ST
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-2434
Country : US
Telephone Number : 307-358-2122
Fax Number : 307-358-7381
Provider Business Practice Location Address
First Line : 111 S 5TH ST
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-2434
Country : US
Telephone Number : 307-358-2122
Fax Number : 307-358-7381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 01/05/2012

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1154385748 — MS. REAGAN JANAE SCOTT O.T.R./L.
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1942264122 — MR. CHARLES ROBERT MANGUS P.T.
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Directions to “ KELLIE DALE CLAUSEN F.N.P.” Practice Location

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