PONY EXPRESS PEDIATRICS LLC NPI 1265087993

NPI Information

PONY EXPRESS PEDIATRICS, LLC is a pediatrics nurse practitioner in Cheyenne, WY. PONY EXPRESS PEDIATRICS, LLC NPI is 1265087993. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1307 CROOK AVE
CHEYENNE, WY
ZIP 82001-412
Phone: (321) 313-3595

The provider's authorized official is Christa Jayleen Kovachevich .
The authorized official title is Owner/aprn Cpnp-pc and has the following contact phone number (321) 313-3595.

The CLIA number assigned to this NPI record is 53D2171035 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/8/2019 and was last updated on 8/8/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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