NPIMap

Individual provider Active NPI

Kristy H Faddis

  • Respite Care
  • Evanston, WY
National Provider Identifier
1225366925
Registry record updated Oct 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
251C00000X Issued in WY
Practice address
164 Country Way
Evanston, WY 82930-9517
Phone
(307) 789-2875
Fax
(307) 789-2876
NPI assigned
Nov 18, 2009
Last updated
Oct 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 251C00000X WY Primary
Child Mental Illness Respite Care 385HR2055X 251C00000X WY
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X 251C00000X WY
Child Physical Disabilities Respite Care 385HR2065X 251C00000X WY

Addresses

Primary practice location

164 Country Way
Evanston, WY 82930-9517

Mailing address

164 Country Way
Evanston, WY 82930-9517
Phone (307) 679-7387

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
251C00000XWYMDDevelopmentally Disabled Services Day Training Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Five J Support Services LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791763200000",
    "number": "1225366925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 COUNTRY WAY",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309517",
            "telephone_number": "307-679-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 COUNTRY WAY",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309517",
            "telephone_number": "307-789-2875",
            "fax_number": "307-789-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADDIS",
        "first_name": "KRISTY",
        "middle_name": "H",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-18",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "WY",
            "license": "251C00000X",
            "primary": true
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "WY",
            "license": "251C00000X",
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "WY",
            "license": "251C00000X",
            "primary": false
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": "WY",
            "license": "251C00000X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.