MEDICARE: BRIELLE PAGETT PA-C

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	363AM0700X	Medical Physician Assistant	PA1029	WY

General Provider Information

NPI Number	:	1649851080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIELLE PAGETT PA-C

Provider Business Mailing Address
First Line	:	201 E 5TH ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-3658
Country	:	US
Telephone Number	:	307-674-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E 5TH ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-3658
Country	:	US
Telephone Number	:	307-674-6995
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	12/08/2025

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Directions to “ BRIELLE PAGETT PA-C” Practice Location

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