Clausen, Kellie Dale

Clausen, Kellie Dale is an individual health care provider with primary practice located at 111 S 5Th St , Douglas WY 82633-2434. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Clausen, Kellie Dale can be contacted via phone (307) 358-2122.

Contact Information

Primary practice address
111 S 5Th St Douglas WY 82633-2434
Phone: (307) 358-2122
Fax: (307) 358-7381
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 14471-0152 Wyoming

Profile Details

NPI number 1487616553
LBN Legal business name Clausen, Kellie Dale
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Jan 5th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487616553 NPPES
Wyoming MEDICAID 121710100
Wyoming Other 313807

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