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NPI Code Detail

MEDICARE: KATHLEEN VANIER M.D.

MEDICARE: KATHLEEN VANIER M.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
1207R00000XInternal Medicine PhysicianA77195CA
2207R00000XInternal Medicine Physician13781AWY

Other Identifiers

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

General Provider Information

NPI Number : 1790719011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN VANIER M.D.
Provider Business Mailing Address
First Line : PO BOX 428
Second Line :
City : JACKSON
State : WY
Zip : 83001-0428
Country : US
Telephone Number : 307-733-3636
Fax Number : 307-739-7344
Provider Business Practice Location Address
First Line : 625 E BROADWAY AVE BLDG B
Second Line :
City : JACKSON
State : WY
Zip : 83001-8642
Country : US
Telephone Number : 307-739-7450
Fax Number : 307-739-7344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 02/01/2022

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