Active NPI
Kelcey Bullock
- Community Health Worker
- Pine Bluffs, WY
National Provider Identifier
1851713812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 805 Pine St
Pine Bluffs, WY 82082 - Phone
- (307) 245-3444
- NPI assigned
- Jan 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
805 Pine St
Pine Bluffs, WY 82082
Mailing address
805 Pine St
Pine Bluffs, WY 82082
Phone (307) 245-3444
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Wellness Center | 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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pine Bluffs, WY
- NPI 1922391804
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389312000000",
"number": "1851713812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 PINE ST",
"city": "PINE BLUFFS",
"state": "WY",
"postal_code": "82082",
"telephone_number": "307-245-3444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 PINE ST",
"city": "PINE BLUFFS",
"state": "WY",
"postal_code": "82082",
"telephone_number": "307-245-3444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "KELCEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-10",
"last_updated": "2014-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluffs, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.