Active NPI
Sally J Youngbear, R.N.
- Registered Nurse
- Fort Washakie, WY
National Provider Identifier
1871899781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 125860
- Practice address
- 29 Black Coal Dr
Fort Washakie, WY 82514-0128 - Phone
- (307) 332-7300
- Fax
- (307) 332-0131
- NPI assigned
- Feb 10, 2011
- Last updated
- Feb 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 125860 | IA | Primary |
Addresses
Primary practice location
29 Black Coal Dr
Fort Washakie, WY 82514-0128
Mailing address
185 Custer St
Apt 5
Lander, WY 82520
Phone (614) 481-0683
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105726000 | Medicaid | WY |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125860 | IA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297296000000",
"number": "1871899781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "185 CUSTER ST",
"address_2": "APT 5",
"city": "LANDER",
"state": "WY",
"postal_code": "82520",
"telephone_number": "614-481-0683",
"fax_number": "307-332-0131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 BLACK COAL DR",
"city": "FORT WASHAKIE",
"state": "WY",
"postal_code": "825140128",
"telephone_number": "307-332-7300",
"fax_number": "307-332-0131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBEAR",
"first_name": "SALLY",
"middle_name": "J",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-10",
"last_updated": "2011-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IA",
"license": "125860",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "105726000",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Washakie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.