NPIMap

Organization Active NPI

Wyoming Wellness Center LLC

  • Certified Registered Nurse Anesthetist
  • Torrington, WY
National Provider Identifier
1922838028
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
WYOMING WELLNESS CENTER LLC
Doing business as
Wyoming Wellness Center - Ketamine
Practice address
601 Niobrara Ave
Torrington, WY 82240-1522
Phone
(307) 532-3035
Fax
(307) 275-9533
NPI assigned
Aug 3, 2024
Organization subpart
Yes
Parent organization
WYOMING WELLNESS CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Authorized official

Name
Tracy Rene' Richard, CRNANPI 1154697167
Title
Owner / Provider
Phone
(307) 532-3035

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Management Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

601 Niobrara Ave
Torrington, WY 82240-1522

Mailing address

601 Niobrara Ave
Torrington, WY 82240-1522
Phone (307) 532-3035

Other practice location 1

1705 Albany Ave
Cheyenne, WY 82001-5027
Phone (307) 532-3035

Other names 1

  • Wyoming Wellness Center - Ketamine Doing business as

National Provider Directory

National Provider Directory
Part of
Wyoming Wellness Center LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1922838028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 NIOBRARA AVE",
            "city": "TORRINGTON",
            "state": "WY",
            "postal_code": "822401522",
            "telephone_number": "307-532-3035",
            "fax_number": "307-275-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 NIOBRARA AVE",
            "city": "TORRINGTON",
            "state": "WY",
            "postal_code": "822401522",
            "telephone_number": "307-532-3035",
            "fax_number": "307-275-9533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1705 Albany Ave",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820015027",
            "country_code": "US",
            "telephone_number": "307-532-3035",
            "fax_number": "307-275-9533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYOMING WELLNESS CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYOMING WELLNESS CENTER LLC",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "RICHARD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "RENE'",
        "authorized_official_title_or_position": "OWNER / PROVIDER",
        "authorized_official_telephone_number": "307-532-3035",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Pain Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wyoming Wellness Center - Ketamine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Torrington, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.