MEDICARE: JANA GURKIN PPC

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	101YP2500X	Professional Counselor	1378	WY

General Provider Information

NPI Number	:	1720831266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA GURKIN PPC

Provider Business Mailing Address
First Line	:	141 S CENTER ST STE 304
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2543
Country	:	US
Telephone Number	:	307-333-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 S CENTER ST STE 304
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2543
Country	:	US
Telephone Number	:	307-333-4028
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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Directions to “ JANA GURKIN PPC” Practice Location

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