MEDICARE: KENNETH WAYNE EGLE

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1891509394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WAYNE EGLE

Provider Business Mailing Address
First Line	:	PO BOX 2134
Second Line	:
City	:	PINEDALE
State	:	WY
Zip	:	82941-2134
Country	:	US
Telephone Number	:	307-231-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 14TH AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-1403
Country	:	US
Telephone Number	:	307-231-5052
Fax Number	:

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

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ KENNETH WAYNE EGLE ” Practice Location

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