Roger E Brazelton
Individual provider Active NPI Community Health Worker · Cody, WY
NPI 1386083103 · NPPES record last updated Jun 14, 2013
Key facts
- NPI
- 1386083103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 2713 Cougar Ave
Cody, WY 82414-8400 - Phone
- (307) 587-5112
- Fax
- (307) 587-5446
- NPI assigned
- Jun 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
2713 Cougar Ave
Cody, WY 82414-8400
Mailing address
2538 Big Horn Ave
Cody, WY 82414-9299
Phone (307) 587-2197
Other providers in Cody, WY
- Rachael M. Bracke
- Sierra Bradley
- Tina Braetthomas
- Brandi R Shepard LLC
- Catherine Brasher
- Linda Brazney
- Breathe & Balance LLC
- Christina Brewer
- Heather Peatross Brinkerhoff
- Kristanza Marie Bronnenberg
All providers in Cody, WY · Community Health Worker in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.