| Healthy Lifestyle Medicine | |
|
6015 Sycamore Rd Cheyenne WY 82009-4347 | |
| (307) 823-2968 | |
| Not Available |
| Full Name | Healthy Lifestyle Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 6015 Sycamore Rd, Cheyenne, Wyoming |
| Authorized Official Name and Position | Kristine Van Kirk (OWNER/PROVIDER) |
| Authorized Official Contact | 3078232968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Lifestyle Medicine 6015 Sycamore Rd Cheyenne WY 82009-4347 Ph: (307) 823-2968 | Healthy Lifestyle Medicine 6015 Sycamore Rd Cheyenne WY 82009-4347 Ph: (307) 823-2968 |
| NPI Number | 1912478819 |
|---|---|
| Provider Enumeration Date | 12/17/2018 |
| Last Update Date | 12/20/2018 |
| Medicare PECOS PAC ID | 3577802941 |
|---|---|
| Medicare Enrollment ID | O20190301000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912478819 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| 2083B0002X | Preventive Medicine - Obesity Medicine | (* (Not Available)) | Secondary |
| Provider Name | Kelly Gebauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356964464 PECOS PAC ID: 0840692596 Enrollment ID: I20210716002411 |
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