KINTSUGI PSYCHIATRY LLC NPI 1306406509

NPI Information

NPI: 1306406509
Provider Name: KINTSUGI PSYCHIATRY, LLC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
145 S DURBIN ST STE 108
CASPER, WY
ZIP 82601
Phone: (307) 333-5757
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KINTSUGI PSYCHIATRY, LLC is a psychiatric/mental health nurse practitioner in Casper, WY. KINTSUGI PSYCHIATRY, LLC NPI is 1306406509. The provider is registered as an organization entity type.

The provider's business location address is:

145 S DURBIN ST STE 108
CASPER, WY
ZIP 82601-566
Phone: (307) 333-5757
Fax: (307) 439-2141

The provider's authorized official is Katie Madetzke .
The authorized official title is Practice Manager and has the following contact phone number (307) 333-5757.

The enumeration date for this NPI number is 6/19/2019 and was last updated on 6/17/2022.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1306406509	MEDICAID	WYOMING
2	1093117210	MEDICAID	WYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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