| Kintsugi Psychiatry, Llc | |
|
145 S Durbin St Ste 108 Casper WY 82601-2566 | |
| (307) 333-5757 | |
| (307) 439-2141 |
| Full Name | Kintsugi Psychiatry, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 145 S Durbin St Ste 108, Casper, Wyoming |
| Authorized Official Name and Position | Katie Madetzke (PRACTICE MANAGER) |
| Authorized Official Contact | 3073335757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintsugi Psychiatry, Llc Po Box 1117 Casper WY 82602-1117 Ph: (307) 333-5757 | Kintsugi Psychiatry, Llc 145 S Durbin St Ste 108 Casper WY 82601-2566 Ph: (307) 333-5757 |
| NPI Number | 1306406509 |
|---|---|
| Provider Enumeration Date | 06/19/2019 |
| Last Update Date | 06/17/2022 |
| Certification Date | 03/23/2022 |
| Medicare PECOS PAC ID | 5991030736 |
|---|---|
| Medicare Enrollment ID | O20190716001355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306406509 | NPI | - | NPPES |
| 1306406509 | Medicaid | WY | |
| 1093117210 | Medicaid | WY |
| Provider Name | Teecee Ann Hailey-fulfer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093117210 PECOS PAC ID: 0446524961 Enrollment ID: I20171101003339 |
| Provider Name | Crystal Lynn Bardgett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508517368 PECOS PAC ID: 5496149437 Enrollment ID: I20220308001818 |
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