Carly Jane Wasserbach, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

53202 Issued in WY

Practice address

2862 Ardon LN
Casper, WY 82609-3900

Phone

(307) 249-3543

Fax

(904) 748-2569

NPI assigned

Feb 5, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 28, 2025 through Aug 28, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wyoming Psychiatry & Consultation LLC

  • Psychiatry Physician
  • Casper, WY
  • NPI 1083370258
  NPD
• Teton Wellness Affiliates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, WY
  • NPI 1407480890
  NPD (past)

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1962265793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2862 ARDON LN",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826093900",
            "telephone_number": "307-249-3543",
            "fax_number": "904-748-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2862 ARDON LN",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826093900",
            "telephone_number": "307-249-3543",
            "fax_number": "904-748-2569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERBACH",
        "first_name": "CARLY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WY",
            "license": "53202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erienne Warner, RN
• Trevor Patrick Warren, PCSW-1031
• Wayne Lee Warren Jr., MD
• Emily Washut, OTR/L
• Travis Paul Washut, D.O.
• James Nymphas Watson, PT
• Andrew Curtis Weaver, PMHNP-BC
• Jason D Weaver, M.S. LPC
• Seiko Jo Webb, BS
• Lisa A Weber, RN

• Psychiatric/Mental Health Nurse Practitioner in Casper, WY
• Providers in Casper, WY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.