Wyoming Wic Program

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

Legal business name

WYOMING WIC PROGRAM

Practice address

6101 Yellowstone Road
Suite 510
Cheyenne, WY 82002-0001

Phone

(307) 777-7494

Fax

(307) 777-5643

NPI assigned

Aug 14, 2007

Organization subpart

No

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

Authorized official

Name

Jean A Bouley

Title

Administrative Specialist 3

Phone

(307) 777-7494

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1366634396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 YELLOWSTONE ROAD",
            "address_2": "SUITE 510",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820020001",
            "telephone_number": "307-777-7494",
            "fax_number": "307-777-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 YELLOWSTONE ROAD",
            "address_2": "SUITE 510",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820020001",
            "telephone_number": "307-777-7494",
            "fax_number": "307-777-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING WIC PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "BOULEY",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATIVE SPECIALIST 3",
        "authorized_official_telephone_number": "307-777-7494"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366634396",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wyoming Sciences LLC
• Wyoming Sleep Disorders Center
• Wyoming Spine & Neurosurgery
• Wyoming Spine and Neurosurgery Associates,LLC
• Wyoming Vein LLC
• Wyostep, Inc.
• Andrea Lynn Wysong, MS, RDN
• Gerald Yaffa
• Weeranuj Yamreudeewong, PHARM.D.
• Yana Counseling, LLC

• Public Health or Welfare Agency in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Public Health or Welfare Agency in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; 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.