Princika KC, DNP, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Cheyenne, WY
NPI 1750003083 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1750003083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 43353 (WY)
- Practice address
- 2508 E Fox Farm Rd Ste 1a
Cheyenne, WY 82007-2559 - Phone
- (307) 635-3618
- NPI assigned
- Sep 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cheyenne Health and Wellness Center
Practice addresses (Care Compare)
2508 E Fox Farm Rd
Suite 1a
Cheyenne, WY 82007-2559
Phone (307) 635-3618
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240614001898 | WY | Practitioner - Nurse Practitioner | 6204379506 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43353 | WY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cheyenne Health & Wellness Center | Current |
Accepting new patients | |
| Gold Diagnostics Corp | Current |
Accepting new patients | |
| Cheyenne Health & Wellness Center | Current |
Accepting new patients | |
| Haelen Mental Health, PLLC | Psychiatric/Mental Health | Past | Accepting new patients |
Locations
10101 Fondren Rd
Ste 112
Houston, TX 77096
Phone (281) 912-3264
2508 E Fox Farm Rd
Ste 1A
Cheyenne, WY 82007
Phone (307) 635-3618
1851 Big Horn Ave
Sheridan, WY 82801
Phone (307) 674-4416
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 43353 | WY | Yes |
Addresses
Primary practice location
2508 E Fox Farm Rd Ste 1a
Cheyenne, WY 82007-2559
Mailing address
2508 E Fox Farm Rd Ste 1a
Cheyenne, WY 82007-2559
Other providers in Cheyenne, WY
- Kayla Kauffman
- Karen Ann Kaumo
- Jessica Kautzman
- Quinlan Kautzman
- Muriah Lynne Kayser
- Kelsey J Kean
- Megan Kearney
- Krysten Keck
- Sharon Keck
- Amanda C Keefe
All providers in Cheyenne, WY · Psychiatric/Mental Health Nurse Practitioner in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.