MEDICARE: WHITE POPPY 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	:	1558236950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE POPPY LLC

Provider Business Mailing Address
First Line	:	800 WERNER CT STE 125
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1323
Country	:	US
Telephone Number	:	307-289-8364
Fax Number	:	800-994-6075

Provider Business Practice Location Address
First Line	:	800 WERNER CT STE 125
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1323
Country	:	US
Telephone Number	:	307-289-8364
Fax Number	:	800-994-6075

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JAYME DONALDSON
Credential	:	DNP
Telephone Number	:	307-289-8364

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	01/14/2026

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Directions to “WHITE POPPY LLC ” Practice Location

Language	Start Address	Practice Location

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